Clinical characteristics and prognosis analysis of 53 cases of drowning in children
彭迎港 1谢乐云 1余阗 1王涛 1杨乐 1曾赛珍 1祝益民 1李巍
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作者信息
1. 湖南师范大学附属第一医院（湖南省人民医院）儿童医学中心，长沙 410005
折叠
摘要
目的 总结淹溺患儿临床特征及急救措施，为儿童淹溺的救治及预防提供科学依据。 方法 回顾性总结2011年1月至2021年12月湖南师范大学附属第一医院（湖南省人民医院）儿童医学中心收治的淹溺儿童临床资料。根据时间跨度分为两个阶段，第一阶段（2011至2016年）和第二阶段（2017至2021年），根据格拉斯哥-匹兹堡脑功能表现分级评估量表评估神经学预后，将心跳骤停患儿分为神经功能预后良好组和预后不良组。对不同时间段、不同预后的溺水患儿的基线特征、院前急救及预后等进行分析。 结果 研究期间共纳入53例患儿，第一阶段（2011至2016年）24例，第二阶段（2017至2021年）29例。其中男孩占73.6%（39/53），年龄范围为1个月24 d～14岁，其中1～4岁最为常见，占58.5%（31/53），发生淹溺季节以夏季多见（39.6%，21/53）。11.3%患儿有明显神经系统后遗症，病死率为3.8%（2/53）。同第一阶段相比，第二阶段淹溺控水的比例有所下降（37.5% 比 13.79%，P=0.046）。32例（60.4%）患儿淹溺后经历现场心肺复苏，其中神经学预后良好组24例，神经学预后不良组8例。预后不良组患儿需要心肺复苏持续时间长[10.00（1.50，25.00）min]，入院时体温、格拉斯哥昏迷评分、pH值较低，血糖水平较高（P均＜0.05）。 结论 淹溺多见于学龄前儿童，男孩常见，针对幼童的防淹溺措施理应重点关注。在淹溺时发现心脏骤停的患儿，其淹溺时间及心肺复苏持续时间长，预示着神经学预后不良，及时有效的现场心肺复苏是降低溺亡率的关键。 Objective To summarize the clinical characteristics and first aid measures of children with drowning，and to provide scientific basis for the treatment and prevention of drowning in children. Methods The clinical data of drowning children admitted to the Children's Medical Center of the First Affiliated Hospital of Hunan Normal University（Hunan Provincial People's Hospital）from January 2011 to December 2021 were retrospectively summarized. Baseline characteristics，prehospital emergency care and prognosis of the included children were analyzed.According to the time span, drowning children were divided into two stages, the first stage (2011-2016) and the second stage (2017-2021). According to cerebral performance category assessment scale,drowning children with cardiac arrest were divided into two groups: a group with good neurological prognosis and a group with poor neurological prognosis. The baseline characteristics,pre-hospital emergency care, and prognosis of drowning children during different periods and with different prognosis were analyzed. Results A total of 53 children were enrolled during the study period，with 24 cases in the first phase（2011-2016）and 29 cases in the second phase（2017-2021）.Boys accounted for 73.6%（39/53）of the cases, the age ranged from 1 month and 24 days to 14 years old，with 1-4 years old being the most common，accounting for 58.5%（31/53）, and the season in which drowning occurred was more common in the summer（39.6%, 21/53）.Six cases (11.3%) had significant neurological sequelae, and the mortality rate was 3.8%（2/53）.There was a decrease in the proportion of drowning with water control in the second stage compared to the first stage（37.5% vs. 13.79%,P=0.046）.Thirty-two（60.4%）children experienced on-site cardiopulmonary resuscitation(CPR) after drowning，with 24 cases in the group with good neurological prognosis and 8 cases in the group with poor neurological prognosis.Children in the poor neurological prognosis group required CPR for a long duration [10.00（1.50, 25.00）min]，had lower body temperature，Glasgow Coma Score，pH and higher blood glucose levels on admission（all P < 0.05）. Conclusion Drowning is most common in preschool children，common in boys，and drowning prevention measures for young children deserve focused attention. Children found to be in cardiac arrest at the time of drowning have a long duration of drowning and CPR，which predicts a poor neurological prognosis，and timely and effective on-site CPR is the key to reducing the drowning rate.
Abstract
Objective To summarize the clinical characteristics and first aid measures of children with drowning，and to provide scientific basis for the treatment and prevention of drowning in children. Methods The clinical data of drowning children admitted to the Children's Medical Center of the First Affiliated Hospital of Hunan Normal University（Hunan Provincial People's Hospital）from January 2011 to December 2021 were retrospectively summarized. Baseline characteristics，prehospital emergency care and prognosis of the included children were analyzed.According to the time span, drowning children were divided into two stages, the first stage (2011-2016) and the second stage (2017-2021). According to cerebral performance category assessment scale,drowning children with cardiac arrest were divided into two groups: a group with good neurological prognosis and a group with poor neurological prognosis. The baseline characteristics,pre-hospital emergency care, and prognosis of drowning children during different periods and with different prognosis were analyzed. Results A total of 53 children were enrolled during the study period，with 24 cases in the first phase（2011-2016）and 29 cases in the second phase（2017-2021）.Boys accounted for 73.6%（39/53）of the cases, the age ranged from 1 month and 24 days to 14 years old，with 1-4 years old being the most common，accounting for 58.5%（31/53）, and the season in which drowning occurred was more common in the summer（39.6%, 21/53）.Six cases (11.3%) had significant neurological sequelae, and the mortality rate was 3.8%（2/53）.There was a decrease in the proportion of drowning with water control in the second stage compared to the first stage（37.5% vs. 13.79%,P=0.046）.Thirty-two（60.4%）children experienced on-site cardiopulmonary resuscitation(CPR) after drowning，with 24 cases in the group with good neurological prognosis and 8 cases in the group with poor neurological prognosis.Children in the poor neurological prognosis group required CPR for a long duration [10.00（1.50, 25.00）min]，had lower body temperature，Glasgow Coma Score，pH and higher blood glucose levels on admission（all P < 0.05）. Conclusion Drowning is most common in preschool children，common in boys，and drowning prevention measures for young children deserve focused attention. Children found to be in cardiac arrest at the time of drowning have a long duration of drowning and CPR，which predicts a poor neurological prognosis，and timely and effective on-site CPR is the key to reducing the drowning rate.
关键词
儿童/淹溺/意外伤害/心肺复苏/临床特征
Key words
Children/Drowning/Accidental injury/Cardiopulmonary resuscitation/Clinical features
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