目的:本研究旨在评估延迟重复空气灌肠(DRE)镇静在小儿肠套叠中的临床应用。
方法:回顾性评估首都医科大学附属北京儿童医院急诊科2016年1月至2019年8月空气灌肠整复治疗特发性肠套叠的病例。根据DRE镇静治疗的结果,将纳入的病例分为成功或失败组。一般患者信息,临床表现,测试结果,和手术情况进行比较分析。
结果:共3052例初步诊断为肠套叠,行空气灌肠整复术。最终,包括211例,成功组162人,失败组49人。DRE镇静成功率为76.8%(162/211),总体复位成功率为97.8%(2984/3052)。单因素logistic回归分析显示,失败组患者年龄≤1岁的比例明显增高,血淋淋的凳子,与成功组相比,DRE前左侧肠套叠(OR=2.3,95CI:1.1~4.6,P=0.023;OR=3.4,95CI:1.6~7.2,P=0.002;OR=12.6,95CI:4.6~34.6,P<0.001)。基于这三个因素的多元logistic回归分析显示,DRE前左侧肠套叠患者的DRE失败风险高10.1倍。
结论:DRE联合镇静可提高肠套叠的整体灌肠复位成功率,具有良好的可行性和安全性。DRE前左侧肠套叠是灌肠失败的独立危险因素。
OBJECTIVE: This study aimed to evaluate the clinical application of delayed repeated air
enema (DRE) with sedation in pediatric intussusception.
METHODS: We retrospectively assessed cases of idiopathic intussusception treated with air
enema reduction at the emergency department of Beijing Children\'s Hospital affiliated to Capital Medical University from January 2016 to August 2019. The included cases were assigned to the success or failure groups based on the outcomes of DRE with sedation. General patient information, clinical manifestations, test results, and surgical conditions were collected for comparative analysis.
RESULTS: A total of 3052 cases were initially diagnosed with intussusception and underwent air
enema reduction. Ultimately, 211 cases were included, with 162 in the success group and 49 in the failure group. The success rate of DRE with sedation was 76.8% (162/211), with an overall reduction success rate of 97.8% (2984/3052). Univariate logistic regression analysis showed that patients in the failure group had a significantly higher proportion of patients with age ≤1 year, bloody stools, and left-sided intussusception before DRE compared to the success group (OR = 2.3, 95%CI: 1.1∼4.6, P = 0.023; OR = 3.4, 95%CI: 1.6∼7.2, P = 0.002 and OR = 12.6, 95%CI: 4.6∼34.6, P < 0.001). Multiple logistic regression analysis based on these three factors revealed that the risk of DRE failure was 10.1 times higher in cases with the left-sided intussusception before DRE.
CONCLUSIONS: DRE with sedation can improve the overall
enema reduction success rate for intussusception and has good feasibility and safety profiles. Left-sided intussusception before DRE is an independent risk factor for
enema failure.