前瞻性验证简化卧床休息方案在儿童钝性脾和肝损伤治疗中的应用。

Prospective validation of an abbreviated bedrest protocol in the management of blunt spleen and liver injury in children.

机构信息

The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO 64108, USA.

出版信息

J Pediatr Surg. 2011 Jan;46(1):173-7. doi: 10.1016/j.jpedsurg.2010.09.079.

DOI:10.1016/j.jpedsurg.2010.09.079

PMID:21238661

Abstract

PURPOSE

The aim of this study was to validate the safety, and quantify the impact of, an abbreviated protocol for blunt spleen/liver injury (BSLI), we instituted a prospective study with early ambulation.

METHODS

Following institutional review board approval, data were collected prospectively in all patients with BSLI up to 8 weeks after discharge. There were no exclusion criteria, and patient accrual was consecutive. Bedrest was restricted to 1 night for grade I and II injuries and 2 nights for grade III or higher.

RESULTS

A total of 131 patients with BSLI were enrolled. Injuries included isolated spleen in 72 (55%), liver only in 55 (42%), and both in 4 (3%). One splenectomy was required for a grade 5 injury. Transfusions were used in 24 patients, with 18 patients undergoing transfusion because of injured solid organ. Bedrest was applicable to 110 patients (84%), for which the mean grade of injury was 2.6 and mean bedrest was 1.6 days. The need for bedrest was the limiting factor for length of stay in 86 patients (66%). There were 2 deaths, and no patients were readmitted.

CONCLUSIONS

An abbreviated protocol of 1 night of bedrest for grade I and II injuries and 2 nights for grade III or higher can be safely used, resulting in dramatic decreases in hospitalization compared with the current American Pediatric Surgical Association recommendations.

摘要

目的

本研究旨在验证简化的钝性脾/肝损伤（BSLI）方案的安全性，并量化其影响，我们开展了一项前瞻性研究，采用早期活动。

方法

在获得机构审查委员会批准后，对所有出院后 8 周内发生 BSLI 的患者进行前瞻性数据收集。无排除标准，患者入组为连续入组。对于 I 级和 II 级损伤，卧床休息限制为 1 晚，对于 III 级或更高损伤，卧床休息限制为 2 晚。

结果

共纳入 131 例 BSLI 患者。损伤包括单纯脾损伤 72 例（55%）、单纯肝损伤 55 例（42%）、脾肝同时损伤 4 例（3%）。1 例 5 级损伤需要行脾切除术。24 例患者需要输血，18 例因实质性器官损伤而行输血治疗。110 例（84%）患者适用卧床休息，平均损伤等级为 2.6，平均卧床休息时间为 1.6 天。卧床休息的需求是 86 例患者（66%）住院时间延长的限制因素。有 2 例死亡，无患者再入院。