Anderson Julie, Furnival Ronald A, Zhang Lei, Lunos Scott A, Sadiq Zujaja, Strutt Jonathan R, Kaila Rahul, Hendrickson Marissa A
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
Clinical and Translational Science Institute/Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota.
J Emerg Med. 2019 Oct;57(4):461-468. doi: 10.1016/j.jemermed.2019.07.009. Epub 2019 Oct 5.
Children presenting to pediatric emergency departments (EDs) are frequently given enemas for relief of constipation symptoms; there is very little literature guiding solution selection.
Our aim was to assess and compare the efficacy of the various enema solutions used in a pediatric ED, including the "pink lady," a previously unreported compounded combination of docusate, magnesium citrate, mineral oil, and sodium phosphate.
We identified all children who received any enema over a 5-year period in an urban, quaternary care pediatric ED for inclusion in the study via electronic record review. Physician investigators retrospectively reviewed routine visit documentation to confirm the type and dosage of enema and assess comorbidities, indications, efficacy, and side effects. Subjective descriptions of output were classified as none, small, medium, or large by reviewer consensus.
There were 768 records included. Median age was 6.2 years (interquartile range 3.3-10.3 years). Solutions used were sodium phosphate (n = 396), pink lady (n = 198), soap suds (n = 160), and other (n = 14). There was no significant difference in output by solution type (p = 0.88). Volume delivered was highest for pink lady, with no significant association between volume delivered and output (p = 0.48). Four percent of patients had side effects. Soap suds had a significantly higher rate of side effects (10.6%; p = 0.0003), primarily abdominal pain.
There was no significant difference in reported stool output produced by sodium phosphate, soap suds, and pink lady enemas in children treated in an ED. Further study via randomized controlled trials would be beneficial in guiding selection of enema solution.
前往儿科急诊科就诊的儿童常因便秘症状接受灌肠治疗；但指导溶液选择的文献非常少。
我们的目的是评估和比较儿科急诊科使用的各种灌肠溶液的疗效，包括“粉红女士”，一种以前未报道过的由多库酯、柠檬酸镁、矿物油和磷酸钠混合而成的化合物。
我们通过电子病历审查，确定了在一家城市四级医疗儿科急诊科5年内接受任何灌肠治疗的所有儿童纳入研究。医生研究人员回顾性审查常规就诊记录，以确认灌肠的类型和剂量，并评估合并症、适应症、疗效和副作用。根据评审人员的共识，将排出物的主观描述分为无、少、中或多。
共纳入768份记录。中位年龄为6.2岁（四分位间距3.3 - 10.3岁）。使用的溶液有磷酸钠（n = 396）、粉红女士（n = 198）、肥皂水（n = 160）和其他（n = 14）。溶液类型对排出物无显著差异（p = 0.88）。粉红女士的给药量最高，给药量与排出物之间无显著关联（p = 0.48）。4%的患者有副作用。肥皂水的副作用发生率显著更高（10.6%；p = 0.0003），主要是腹痛。
在急诊科接受治疗的儿童中，磷酸钠、肥皂水和粉红女士灌肠剂产生的报告粪便排出量无显著差异。通过随机对照试验进行进一步研究将有助于指导灌肠溶液的选择。
