PDF(Pubmed)
Abstract：
Infantile hypertrophic pyloric stenosis (IHPS) is a condition whereby there is a thickening of the pyloric muscle, leading to obstruction of the gastric outflow. Typically present within three to five weeks of life, it presents as postprandial non-bilious projectile vomiting. Commonly, a pyloromyotomy is the gold standard to relieve the obstruction. However, in a subset of patients not amenable to undergo surgery or anesthesia, or for postoperative persistent or recurrent obstruction, atropine may offer an alternative treatment. A retrospective review was performed on pediatric patients with hypertrophic pyloric stenosis utilizing the electronic medical record. Data included were demographics, workup data, treatment, outcomes, and symptom resolution. Approval was obtained by the institutional review board of the host institution. Five pediatric patients, with an average age of 2.1 months, received atropine treatment for IHPS. The average time to reach full feeds since the initiation of atropine was approximately four days. Three of the five patients were successfully managed with IV atropine, which was then transitioned to oral atropine and tapered off as outpatients, leading to the resolution of symptoms. The remaining two patients were considered failures of medical management and subsequently required surgery. Atropine use as an alternative treatment for IHPS may be considered when patients are not able to undergo surgery or anesthesia or have recurrent or persistent obstructive symptoms postoperatively. In this limited study, atropine was found to be safe and effective. Randomized controlled studies may lend additional merit to this therapy in the future.
摘要：
婴儿肥厚性幽门狭窄（IHPS）是幽门肌增厚的一种疾病，导致胃流出道阻塞。通常在生命的三到五个星期内出现，表现为餐后非胆汁性抛射性呕吐。通常,幽门切开术是解除梗阻的金标准。然而,在不适合接受手术或麻醉的患者中，或术后持续性或复发性梗阻，阿托品可以提供另一种治疗方法.利用电子病历对肥厚性幽门狭窄的儿科患者进行了回顾性审查。数据包括人口统计，工作数据，治疗,结果，和症状解决。得到东道机构机构审查委员会的批准。五名儿科患者,平均年龄为2.1个月，接受阿托品治疗IHPS。自阿托品开始以来达到完全进食的平均时间约为四天。五名患者中有三名成功接受了阿托品静脉注射治疗，然后过渡到口服阿托品，作为门诊病人逐渐减少，导致症状的解决。其余两名患者被认为是医疗管理失败，随后需要手术。当患者无法接受手术或麻醉或术后有复发或持续的阻塞性症状时，可以考虑使用阿托品作为IHPS的替代治疗。在这项有限的研究中，阿托品被认为是安全有效的.随机对照研究可能会在将来为这种疗法提供额外的价值。
