Page 139 - 南京医科大学学报自然科学版

第43卷第6期 南京医科大学学报（自然科学版）
2023年6月 Journal of Nanjing Medical University（Natural Sciences） ·881 ·

·综 述·

儿童多发伤的评估进展

祁红玉 ，陆巍峰 ，郑朋飞 2
1*
1
南京医科大学附属儿童医院外科重症监护室，骨科，江苏 南京 210026
1 2

［摘 要］ 多发伤是急诊常见的危重症，儿童多发伤更有其自身的临床特点。早期识别、精准诊断、正确评估是降低多发伤致
残率、病死率的关键。目前儿童创伤评分种类繁多，且越来越多的预测模型被提出，可有效判断病情严重程度及预测预后。在
成像方式及时机选择上需考虑患儿状态、损伤情况、准确度及有无辐射等多种因素。影像学的发展提高了对疾病的认识，也对
接诊医生提出了更高的要求。实验室检查同样可以明确诊断及预测并发症，但在时效性及获取难易程度方面参差不齐。对于
多发伤患儿，结合两者进行评估更合适。随着研究的深入，多发伤的评估更加精细，但在儿童这一群体中仍有一定局限性，存
在较大发展空间。
［关键词］ 多发伤；儿童；诊断成像；生物标志物
［中图分类号］ R726 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）06⁃881⁃05
doi：10.7655/NYDXBNS20230621

Progress in the assessment of multiple trauma in pediatrics

1*
1
QI Hongyu ，LU Weifeng ，ZHENG Pengfei 2
2
1 Surgical Intensive Care Unit，Orthopedics Department，the Affiliated Children’s Hospital of Nanjing Medical
University，Nanjing 210026，China

［Abstract］ Multiple trauma is a common critical disease in emergency department，and multiple trauma in children has its own
clinical characteristics. Early identification，accurate diagnosis and correct evaluation are the keys to reduce the rate of disability and
mortality. At present，there are many kinds of pediatric trauma scores，and more and more prediction models have been proposed，
which can effectively judge the severity of the disease and predict the prognosis. In the selection of imaging method and timing，many
factors should be considered，such as the state of the child，injury，accuracy and radiation. The continuous development of diagnostic
imaging has improved the understanding of diseases and put forward higher requirements for doctors. Laboratory examination can also
clearly diagnose and predict complications，but its timeliness and accessibility are uneven，and the cost may also need to be considered
clinically. It is more appropriate to evaluate the children with multiple injuries by combining the two methods. With the deepening of
research，the assessment of multiple trauma has been more sophisticated，but there are still certain limitations in children，leaving great
development space.
［Key words］ multiple trauma；pediatrics；diagnostic imaging；biomarker
［J Nanjing Med Univ，2023，43（06）：881⁃885］

多发伤定义为机体在单一致伤因素作用下，同 影像学检查及实验室检查3个方面对儿童多发伤的
时或相继遭受≥2个解剖部位的损伤，其中1处即使 评估进展作如下综述。
单独存在也可危及生命 。儿童耐受力差、沟通能
［1］
1 创伤评分
力差、配合程度不高，容易造成漏诊，致残率和病死
率较高。早期识别、精准诊断、正确评估是降低多 1.1 损伤严重程度评分（injury severity score，ISS）和
发伤致残率、病死率的关键。本文将从评分体系、 新损伤严重程度评分（new injury severity score，NISS）
［2］
1974 年 Baker 等 提出的 ISS 评分目前应用最
［基金项目］ 中国工程院院地合作项目（JS2020X204） 广泛。它把人体划分为头颈部、面部、胸部、腹部和
∗ 盆腔内脏器、四肢和骨盆带、体表 6 个区域，取 3 个
通信作者（Corresponding author），E⁃mail：lulaotou@126.com