Notrica David M
aDepartment of Surgery and Level 1 Pediatric Trauma Center, Phoenix Children's Hospital bUniversity of Arizona College of Medicine - Phoenix cMayo Medical School, Phoenix, Arizona, USA.
Curr Opin Crit Care. 2015 Dec;21(6):531-7. doi: 10.1097/MCC.0000000000000249.
Nonoperative management of pediatric blunt abdominal injury has changed significantly in the last few years.
Improved resource utilization in the diagnosis of pediatric abdominal injury has been described. Hemodynamic status, rather than grade of injury, now guides care. Stable patients spend less time in the hospital, return to school upon discharge, and are allowed lower hemoglobin levels prior to transfusion. ICUs are reserved for those with recent or ongoing bleeding, previously unstable patients, or children with concomitant injuries necessitating ICU. Risk factors for failure and evidence for adjuncts to nonoperative management are emerging. Operative management of certain pancreatic injuries may have more favorable outcomes than nonoperative management.
Sufficient evidence has become available to radically change the management of pediatric abdominal injury, which is being incorporated into new evidence-based management algorithms.
在过去几年中，小儿钝性腹部损伤的非手术治疗方法发生了显著变化。
已有文献报道在小儿腹部损伤诊断中资源利用得到了改善。目前，血流动力学状态而非损伤分级指导治疗。病情稳定的患者住院时间缩短，出院后返校，输血前允许血红蛋白水平更低。重症监护病房（ICU）只用于近期或正在出血的患者、之前病情不稳定的患者或伴有需要ICU治疗的合并伤的儿童。非手术治疗失败的危险因素以及辅助治疗的证据正在出现。某些胰腺损伤的手术治疗可能比非手术治疗有更良好的结果。
已有足够的证据彻底改变小儿腹部损伤的治疗方法，这些证据正被纳入新的循证治疗方案中。
