Lynch Tim, Kilgar Jennifer, Al Shibli Amal
Department of Pediatrics and Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada.
Department of Pediatric Emergency, Children's Hospital, London Health Sciences Center, London, Ontario, Canada.
Curr Pediatr Rev. 2018;14(1):59-63. doi: 10.2174/1573396313666170815100547.
Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Nonoperative management is employed in over 95% of patients. Penetrating injuries are less common but often require operative management. Knowledge of specific mechanisms of injury aids the clinician in the diagnosis of specific injuries. Computed Tomography (CT) is the gold standard in the identification of intra-abdominal injury. Focused Assessment with Sonography for Trauma (FAST) can detect the presence of free fluid suggestive of intra-abdominal injury. In children, the utility of FAST is limited because less than half of pediatric patients with abdominal injury have free fluid. Bowel perforation and pancreatic injuries may not be evident on initial CT scanning of the abdomen. Initial management of the trauma patient in shock includes fluid boluses of normal saline or Ringer's lactate with two, large-bore upper extremity catheters. Transfusion with packed red blood cells is done if the patient remains hypotensive after the second fluid bolus. Emergent laparotomy is indicated in patients with: free intraperitoneal air, hemodynamic instability despite maximal resuscitative efforts (transfusion of greater than 50% of total blood volume), gunshot wound to the abdomen or other penetrating traumas, and evisceration of intraperitoneal contents. Initial FAST followed by abdominal computed tomography is important in the evaluation of the seriously or critically injured patient. The combination of the FAST exam along with selected abdominal computed tomography can further aid in the detection of injuries that may not be clinically apparent.
腹部创伤约占严重创伤儿科患者的25%，是儿童未被识别的致命伤的最常见原因。儿科腹部创伤通常为钝性伤，脾脏是最常受伤的器官。超过95%的患者采用非手术治疗。穿透性损伤较少见，但通常需要手术治疗。了解特定的损伤机制有助于临床医生诊断特定损伤。计算机断层扫描（CT）是识别腹腔内损伤的金标准。创伤超声重点评估（FAST）可检测提示腹腔内损伤的游离液体的存在。在儿童中，FAST的效用有限，因为不到一半的腹部损伤儿科患者有游离液体。肠穿孔和胰腺损伤在腹部初次CT扫描时可能不明显。休克创伤患者的初始治疗包括用生理盐水或乳酸林格氏液进行液体冲击，通过两根大口径上肢导管给药。如果患者在第二次液体冲击后仍低血压，则进行浓缩红细胞输血。出现以下情况的患者需紧急剖腹手术：腹腔内游离气体、尽管进行了最大程度的复苏努力（输血超过总血容量的50%）仍血流动力学不稳定、腹部枪伤或其他穿透性创伤以及腹腔内容物外露。初始FAST检查后进行腹部计算机断层扫描对评估严重或危重伤患者很重要。FAST检查与选定的腹部计算机断层扫描相结合可进一步有助于检测可能在临床上不明显的损伤。
