Anfang Rachel R, Jatana Kris R, Linn Rebecca L, Rhoades Keith, Fry Jared, Jacobs Ian N
Division of Otolaryngology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital and Wexner Medical Center at Ohio State University, Columbus, Ohio.
Laryngoscope. 2019 Jan;129(1):49-57. doi: 10.1002/lary.27312. Epub 2018 Jun 11.
OBJECTIVES/HYPOTHESIS: Ingestion of button batteries (BB) can rapidly lead to caustic esophageal injury in infants and children, resulting in significant morbidity and mortality. To identify novel mitigation strategies, we tested common weakly acidic household beverages, viscous liquids, and Carafate® for their ability to act as protective esophageal irrigations until endoscopic removal of the BB.
Cadaveric and live animal model.
Apple juice, orange juice, Gatorade®, POWERADE®, pure honey, pure maple syrup, and Carafate® were screened using a 3 V lithium (3 V-CR2032) BB on cadaveric porcine esophagus. The most promising in vitro options were tested against a saline control in live American Yorkshire piglets with anode-facing placement of the BB on the posterior wall of the proximal esophagus for 60 minutes. BB voltage and tissue pH were measured before battery placement and after removal. The 10 mL irrigations occurred every 10 minutes from t = 5 minutes. Gross and histologic assessment was performed on the esophagus of piglets euthanized 7 ± 0.5 days following BB exposure.
Honey and Carafate® demonstrated to a significant degree the most protective effects in vitro and in vivo. Both neutralized the tissue pH increase and created more localized and superficial injuries; observed in vivo was a decrease in both full-thickness injury (i.e., shallower depths of necrotic and granulation tissue) and outward extension of injury in the deep muscle beyond surface ulcer margins (P < .05).
In the crucial period between BB ingestion and endoscopic removal, early and frequent ingestion of honey in the household setting and Carafate® in the clinical setting has the potential to reduce injury severity and improve patient outcomes.
NA Laryngoscope, 129:49-57, 2019.
目的/假设：婴幼儿误食纽扣电池（BB）可迅速导致腐蚀性食管损伤，造成严重的发病率和死亡率。为了确定新的缓解策略，我们测试了常见的弱酸性家用饮料、粘性液体和硫糖铝，看它们能否在通过内镜取出纽扣电池之前起到食管保护性冲洗的作用。
尸体和活体动物模型。
使用3伏锂（3V-CR2032）纽扣电池在猪尸体食管上对苹果汁、橙汁、佳得乐、动益加、纯蜂蜜、纯枫糖浆和硫糖铝进行筛选。在活体美国约克夏仔猪中，将纽扣电池阳极朝后放置于食管近端后壁60分钟，针对生理盐水对照组测试最有前景的体外测试选项。在放置电池前和取出后测量纽扣电池电压和组织pH值。从t = 5分钟开始，每10分钟进行10毫升冲洗。在纽扣电池暴露后7±0.5天对安乐死的仔猪食管进行大体和组织学评估。
蜂蜜和硫糖铝在体外和体内均显示出显著的保护作用。两者均中和了组织pH值的升高，并造成更局限和表浅的损伤；在体内观察到全层损伤（即坏死和肉芽组织深度变浅）和深部肌肉损伤超出表面溃疡边缘的向外扩展均减少（P <.05）。
在误食纽扣电池至内镜取出的关键时期，在家中早期频繁摄入蜂蜜以及在临床环境中使用硫糖铝有可能降低损伤严重程度并改善患者预后。
NA 喉镜，129:49 - 57，2019年。
