Miller Melissa K, Dowd Mary Denise, Friesen Craig A, Walsh-Kelly Christine M
Division of Emergency Medical Services, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Pediatr Emerg Care. 2012 Feb;28(2):115-9. doi: 10.1097/PEC.0b013e3182442c0a.
This study aimed to compare efficacy of enema versus polyethylene glycol (PEG) 3350 for pediatric fecal impaction treatment.
We conducted a prospective, randomized comparison of treatments of fecal impaction in children in a pediatric emergency department (ED). Treatment arms were a single milk and molasses enema in the ED or PEG 3350 for 3 days outpatient. Telephone follow-up was done on days 1, 3, and 5. The primary outcome was main symptom improvement. Additional outcomes were stool frequency, consistency, and ease of stool passage. Treatment failures (home enema, ED return, or hospital admission) were tracked.
Seventy-nine subjects participated (39 PEG; 40 enema). At day 1, PEG subjects were less likely to have improved main symptom (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.8) but no difference in other outcomes. Half (54%) in enema arm were reported as upset by ED therapy, whereas no children in PEG arm were upset (P < 0.05). At day 3, more patients in enema arm reported ideal stool consistency (74% vs 38%; P < 0.05). At day 5, no difference between groups was noted. Most treatment failures were in PEG arm (83%; P = 0.08).
This pilot study suggests that disimpaction by enema may be superior to PEG for immediate relief of symptoms. Larger trials are needed to assess any advantage.
本研究旨在比较灌肠与聚乙二醇（PEG）3350治疗小儿粪便嵌塞的疗效。
我们在儿科急诊科对小儿粪便嵌塞治疗进行了一项前瞻性随机对照研究。治疗组分别为在急诊科单次使用牛奶和糖蜜灌肠或门诊使用PEG 3350治疗3天。在第1、3和5天进行电话随访。主要结局是主要症状的改善。其他结局包括排便频率、大便稠度和排便难易程度。追踪治疗失败情况（家庭灌肠、返回急诊科或住院）。
79名受试者参与研究（39名使用PEG；40名接受灌肠）。在第1天，使用PEG的受试者主要症状改善的可能性较小（优势比[OR]，0.3；95%置信区间[CI]，0.1 - 0.8），但在其他结局方面无差异。灌肠组中有一半（54%）的患者表示因急诊科治疗而不适，而PEG组中没有儿童感到不适（P < 0.05）。在第3天，灌肠组中更多患者报告大便稠度理想（74%对38%；P < 0.05）。在第5天，两组之间未发现差异。大多数治疗失败发生在PEG组（83%；P = 0.08）。
这项初步研究表明，灌肠解除嵌塞在立即缓解症状方面可能优于PEG。需要更大规模的试验来评估其任何优势。
