Kulaylat Afif N, Engbrecht Brett W, Pinzon-Guzman Carolina, Albaugh Vance L, Rzucidlo Susan E, Schubart Jane R, Cilley Robert E
Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, PA, USA; Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA, USA.
Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, PA, USA.
J Pediatr Surg. 2014 Sep;49(9):1378-81. doi: 10.1016/j.jpedsurg.2014.01.002. Epub 2014 Jan 28.
Pleural effusion is a potential complication following blunt splenic injury. The incidence, risk factors, and clinical management are not well described in children.
Ten-year retrospective review (January 2000-December 2010) of an institutional pediatric trauma registry identified 318 children with blunt splenic injury.
Of 274 evaluable nonoperatively managed pediatric blunt splenic injures, 12 patients (4.4%) developed left-sided pleural effusions. Seven (58%) of 12 patients required left-sided tube thoracostomy for worsening pleural effusion and respiratory insufficiency. Median time from injury to diagnosis of pleural effusion was 1.5days. Median time from diagnosis to tube thoracostomy was 2days. Median length of stay was 4days for those without and 7.5days for those with pleural effusions (p<0.001) and 6 and 8days for those pleural effusions managed medically or with tube thoracostomy (p=0.006), respectively. In multivariate analysis, high-grade splenic injury (IV-V) (OR 16.5, p=0.001) was associated with higher odds of developing a pleural effusion compared to low-grade splenic injury (I-III).
Pleural effusion following pediatric blunt splenic injury has an incidence of 4.4% and is associated with high-grade splenic injuries and longer lengths of stay. While some symptomatic patients may be successfully managed medically, many require tube thoracostomy for progressive respiratory symptoms.
脾钝性损伤后胸腔积液是一种潜在的并发症。儿童中的发病率、危险因素及临床处理尚未得到充分描述。
对机构性儿科创伤登记处进行十年回顾性研究（2000年1月至2010年12月），确定了318例脾钝性损伤儿童。
在274例可评估的非手术治疗的儿科脾钝性损伤中，12例（4.4%）出现左侧胸腔积液。12例患者中有7例（58%）因胸腔积液恶化和呼吸功能不全需要行左侧胸腔闭式引流术。从受伤到诊断胸腔积液的中位时间为1.5天。从诊断到胸腔闭式引流术的中位时间为2天。无胸腔积液者的中位住院时间为4天，有胸腔积液者为7.5天（p<0.001），胸腔积液经药物治疗或胸腔闭式引流术治疗者分别为6天和8天（p=0.006）。多因素分析显示，与低级别脾损伤（I-III级）相比，高级别脾损伤（IV-V级）（OR 16.5，p=0.001）发生胸腔积液的几率更高。
小儿脾钝性损伤后胸腔积液的发生率为4.4%，与高级别脾损伤和更长的住院时间相关。虽然一些有症状的患者可通过药物治疗成功处理，但许多患者因进行性呼吸症状需要行胸腔闭式引流术。
