138例儿童高空坠落伤临床特点及结局分析

蒋立; 董展; 孙祥水; 张志群; 楼跃

doi:10.16016/j.1000-5404.201907057

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138例儿童高空坠落伤临床特点及结局分析

临床医学 | 更新时间：2026-01-09

- 138例儿童高空坠落伤临床特点及结局分析
- Clinical characteristics and outcomes of children with injuries resulting from high falls: analysis of 138 cases
- 第三军医大学学报 2019年41卷第24期页码：2445-2449
- 作者机构：
  
  210000 南京，南京医科大学附属儿童医院小儿骨科
- 作者简介：
  
  [ 董展, E-mail:dongzhan121@163.com DONG Zhan, E-mail: dongzhan121@163.com
- 基金信息：
  
  江苏省卫生厅面上科研课题(苏卫科教[2018] 30号);南京市医学科技发展项目(医药卫生科研课题)(宁卫科教[2014] 6号)
- DOI：10.16016/j.1000-5404.201907057
  中图分类号： R181.32;R726.42
- 收稿：2019-07-08，
  
  修回：2019-10-07，
  
  纸质出版：2019-12-30
- 稿件说明：
移动端阅览
蒋立, 董展, 孙祥水, 等. 138例儿童高空坠落伤临床特点及结局分析[J]. 第三军医大学学报, 2019,41(24):2445-2449.

Li JIANG, Zhan DONG, Xiangshui SUN, et al. Clinical characteristics and outcomes of children with injuries resulting from high falls: analysis of 138 cases[J]. Journal of Third Military Medical University, 2019, 41(24): 2445-2449.
蒋立, 董展, 孙祥水, 等. 138例儿童高空坠落伤临床特点及结局分析[J]. 第三军医大学学报, 2019,41(24):2445-2449. DOI： 10.16016/j.1000-5404.201907057.

Li JIANG, Zhan DONG, Xiangshui SUN, et al. Clinical characteristics and outcomes of children with injuries resulting from high falls: analysis of 138 cases[J]. Journal of Third Military Medical University, 2019, 41(24): 2445-2449. DOI： 10.16016/j.1000-5404.201907057.

摘要

目的

总结儿童高空坠落伤的流行病学和临床特点，提高救治水平，改善预后，降低死亡率。

方法

收集2012年1月至2019年6月138例高空坠落伤(坠落高度≥2 m)患儿临床资料。男性83例，女性55例，年龄1~14岁，平均4.8岁，其中≤1岁(婴儿期)1例、>1~3岁(幼儿期)24例、>3~7岁(学龄前期)74例和>7~14岁(学龄期)39例。归纳分析患儿坠落场所、入院前后急救及治疗措施，统计患儿创伤严重程度评分(injury severity scase

ISS)。采用统计学方法，对坠落高度和损伤部位构成比等指标进行分析。

结果

坠落高度均≥2 m，其中从窗户和阳台坠落93例、机动车上抛出13例、楼梯坠落11例、平台坠落6例、护栏上坠落2例、屋顶坠落1例、天花板上坠落1例、游乐设施坠落1例、不详10例。坠落高度:

2~3 m 45例、

3~15 m 83例、

15 m 10例。手术治疗45例，对症治疗93例。ISS≤16分46例，ISS

16~25分76例，ISS＞25分16例。住院时间1~15 d，住院中位数5 d，其中39例入住ICU，入住ICU时间3~10 d，入住ICU时间中位数5 d。治愈或好转出院123例、未愈15例，其中7例死亡，4例弥漫性脑肿胀，4例脑疝。儿童高空坠落常发生在3~15 m高的窗户和阳台，最易造成颅脑和胸部损伤。3个不同坠落高度(

2~3 m、

3~15 m和

15 m)和3个不同创伤严重程度评分(injury severity scase

ISS)(≤16分、

16~25分和

25分)的特定损伤部位构成比差异无统计学意义(

0.05)。高空坠落伤高度越高和ISS评分越高，患儿预后不好(

0.05)。

结论

儿童高坠伤以建筑物窗户和阳台坠落最多，同时机动车坠落比例有所增加；坠落高度≥3 m及ISS评分＞25分患儿预后不好。

Abstract

Objective

To summarize the epidemiological and clinical characteristics of children with high fall injuries to improve the treatment and outcomes of the patients.

Methods

We retrospectively collected the clinical data from 138 children who had fall injuries (≥2 m) between January

2012 and June

2019. The patients consisted of 83 boys and 55 girls aged 1-14 years (mean 4.8 years)

including 1 infant (≤1 year old)

24 toddlers (>1-3 years old)

74 preschoolers (>3-7 years old)

and 39 schoolers (>7-14 years old). We analyzed the scenes of the falls

first aid measures before admission

treatments after admission

Injury Severity Scale (ISS) scores

height of falls and injury sites in all the cases.

Results

The children had injuries resulting from falls from windows or balconies (93 cases)

motor vehicles (13 cases)

stairs (11 cases)

high platform (6 cases)

guardrail (2 cases)

roof or ceiling (2 cases)

amusement facilities (1 case)

and unknown places (10 cases). The heights of the falls were

2-3 m in 45 cases

3-15 m in 83 cases

and

15 m in 10 cases. Forty-five children received surgical treatment and 93 had symptomatic treatment. The ISS score ≤16 in 46 cases

16-25 in 76 cases and over 25 in 16 cases. The median length of hospital stay was 5 d (range 1-15 d). Thirty-nine of the children were admitted to ICU with a median ICU time of 5 d (range 3-10 d). Of all the children

123 were discharged with cure or improvement; 15 of the children were not cured

among which 7 died

4 had diffuse brain swelling and 4 had cerebral hernia. In the overall cases

high falls involved most frequently windows and balconies with a height of 3-15 m

which had a high likeliness of causing brain and chest injuries. There was no significant difference in the proportion of specific injury sites among the children with different fall heights (

2-3 m

3-15 m and

15 m) and with different ISS scores (≤16

16-25 and

25) (

0.05). A higher height of the fall was associated w

ith a higher ISS score and a worse prognosis (

0.05).

Conclusion

For children

high falls often occur in windows and balconies

and falls from motor vehicles tend to increase. A comprehensive inspection of multiple parts and systems of the children should be carried out after high fall injuries; a falling height ≥3 m and an ISS score > 25 are both associated with a poor prognosis and a high mortality.

关键词

Keywords

references

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