Allen G S, Cox C S, Moore F A, Duke J H, Andrassy R J
Department of Surgery, University of Texas-Houston Medical School, 77030, USA.
J Am Coll Surg. 1997 Sep;185(3):229-33.
Pulmonary contusion (PC) is a common sequelae of blunt trauma in adults and children; previous reports suggest that children have more favorable outcomes because of differences in mechanisms of injury, associated injury, and physiologic response. Our objective was to determine whether children who sustain PC have different outcomes compared with similarly injured adults.
Our Level I Trauma Registry was reviewed for a 4-year period and identified 251 consecutive patients who sustained PC. Their charts were reviewed retrospectively for demographics, injury mechanism, injury severity scores, associated injuries, and outcomes (measured by the need for intubation, ventilation days, pneumonia, acute respiratory distress syndrome, and death). Data are expressed as the mean +/- SEM. The Student's t-test was used to compare the groups. A p value less than 0.05 was considered significant.
Of the study patients, 41 (16%) were children (ages 2-16, mean 10 years) and 210 (84%) were adults (ages 17-80, mean 34 years). The most common injury mechanisms in children were motor vehicle accidents (56%) and auto-pedestrian accidents (39%), but in adults, motor vehicle accidents (80%, p = 0.02) predominated. Injury severity score was not significantly different between groups (children, 26 +/- 2 and adults 25 +/- 1). Similarly, the incidence of associated injuries was not different between children and adults: head 78% versus 62%, abdomen 59% versus 43%, and skeletal fractures 41% versus 29%, respectively. Neither need for intubation, ventilator days, pneumonia, acute respiratory distress syndrome, or death differed significantly between groups.
Although children and adults differ in regard to injury mechanism, their overall injury severity, associated injuries, and outcomes are quite similar. Thus, contrary to previous reports, children do not have a more favorable outcome after PC.
肺挫伤（PC）是成人和儿童钝性创伤常见的后遗症；既往报告提示，由于损伤机制、合并伤和生理反应的差异，儿童的预后更佳。我们的目的是确定与同样受伤的成人相比，发生PC的儿童是否有不同的预后。
我们回顾了一级创伤登记处4年期间的资料，确定了251例连续发生PC的患者。对他们的病历进行回顾性分析，以获取人口统计学资料、损伤机制、损伤严重程度评分、合并伤及预后（通过插管需求、通气天数、肺炎、急性呼吸窘迫综合征和死亡情况衡量）。数据以均数±标准误表示。采用Student t检验比较两组。p值小于0.05被认为具有统计学意义。
在研究患者中，41例（16%）为儿童（年龄2 - 16岁，平均10岁），210例（84%）为成人（年龄17 - 80岁，平均34岁）。儿童最常见的损伤机制是机动车事故（56%）和汽车与行人碰撞事故（39%），而成人以机动车事故为主（80%，p = 0.02）。两组间损伤严重程度评分无显著差异（儿童为26±2，成人为25±1）。同样，儿童和成人合并伤的发生率也无差异：头部损伤分别为78%和62%，腹部损伤分别为59%和43%，骨折分别为41%和29%。两组在插管需求、通气天数、肺炎、急性呼吸窘迫综合征或死亡方面均无显著差异。
尽管儿童和成人在损伤机制方面存在差异，但他们的总体损伤严重程度、合并伤及预后非常相似。因此，与既往报告相反，儿童发生PC后的预后并非更佳。
