Kim Jung Heon, Lee Jong Seung, Ryu Jeong Min, Lim Kyoung Soo, Kim Won Young
From the Departments of Pediatrics and.
Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Pediatr Emerg Care. 2018 Jul;34(7):484-487. doi: 10.1097/PEC.0000000000001071.
The aim of this study was to identify risk factors for recurrent intussusception after a successful reduction by fluoroscopy-guided air enema, the time required for recurrence, and the association between delayed reduction and the recurrence.
Medical records of 479 consecutive children with intussusception who underwent fluoroscopy-guided air enema between January 2004 and September 2014 were reviewed. Recurrent intussusception was defined as a recurrence within 48 hours of a reduction. Symptom-to-door time was defined as the time from symptom onset to emergency department arrival. Door-to-reduction time was defined as the time from emergency department arrival to reduction. Time-to-recurrence was defined as the time required for recurrence from the first ultrasound diagnosis.
Of the 360 eligible children, 32 had recurrent intussusceptions (8.9%). Multivariable logistic regression showed that age 2 years or older is an independent predictor of recurrent intussusception (odds ratio, 2.39; 95% confidence interval, 1.13-5.02; P = 0.02). Median time to recurrence was 25 hours (18.0-36.0 hours). Although symptom-to-door and door-to-reduction times tended to be longer in the recurrence group, these differences were not significant (12.5 vs 7.0 hours, P = 0.18; 154.0 vs 143.0 minutes, P = 0.67, respectively).
Our data suggest that provision for early recurrence and extended observation may be beneficial for children 2 years or older. Delayed reduction was not associated with recurrent intussusception, but further studies with larger sample sizes are needed to explain this issue.
本研究旨在确定经荧光透视引导下空气灌肠复位成功后复发性肠套叠的危险因素、复发所需时间以及延迟复位与复发之间的关联。
回顾了2004年1月至2014年9月期间479例接受荧光透视引导下空气灌肠的连续性肠套叠患儿的病历。复发性肠套叠定义为复位后48小时内复发。症状到入院时间定义为从症状出现到到达急诊科的时间。入院到复位时间定义为从到达急诊科到复位的时间。复发时间定义为从首次超声诊断到复发所需的时间。
在360例符合条件的患儿中，32例出现复发性肠套叠（8.9%）。多变量逻辑回归显示，2岁及以上是复发性肠套叠的独立预测因素（比值比，2.39；95%置信区间，1.13 - 5.02；P = 0.02）。复发的中位时间为25小时（18.0 - 36.0小时）。虽然复发组的症状到入院时间和入院到复位时间往往更长，但这些差异不显著（分别为12.5小时对7.0小时，P = 0.18；154.0分钟对143.0分钟，P = 0.67）。
我们的数据表明，对于2岁及以上的儿童，考虑到早期复发并进行延长观察可能有益。延迟复位与复发性肠套叠无关，但需要更大样本量的进一步研究来解释这个问题。
