Li Yang, Jiao Han-Liang, Bai Yu-Kun, Wang Ping
Yang Li, Department of Minimally Invasive Surgery, Hebei Children's Hospital, Shijiazhuang, 050031, Hebei, P.R. China.
Han-liang Jiao, Department of Pediatrics, Hebei Children's Hospital, Shijiazhuang, 050031, Hebei, P.R. China.
Pak J Med Sci. 2020 Nov-Dec;36(7):1640-1644. doi: 10.12669/pjms.36.7.3105.
To explore the effect of manipulative reduction combined with air enema on intestinal mucosal immune function in children with intussusception.
This is a prospective randomized controlled study in which 60 children with primary intussusception admitted to Hebei Children's Hospital from October 2018 to October 2019 were selected for this study. They were randomly divided into two groups. The 30 patients in the experimental group underwent manipulative reduction and air enema reduction, and 30 patients in the control group underwent only air enema reduction. Pain scores and pressure during enema were recorded and analyzed. Fasting blood of children in the experimental group were drawn to test the serum T lymphocyte subsets CD3+, CD4+, CD8+ levels, B lymphocyte subsets CD19+ level, and NK cell subsets CD56+ levels before reduction. Among them, fasting blood of 28 children with successful reduction were drawn again in the morning after reduction, and the indicators of each immune cell subgroup before and after reduction were analyzed. Two children with unsuccessful reduction were no longer tested for these indicators.
Twenty-Eight children in the experimental group had successful reduction, and two children with unsuccessful reduction were changed to open surgery (28/30). Twenty five Children in the control group had successful reduction, and five were changed to open surgery (25/30). There was no significant difference in the success rate of reduction between two groups (p>0.05). Close observation for 12~24h after reduction found that none of the children had signs of peritonitis. The pain score and reduction pressure of the observation group were lower than those of the control group, and the difference was statistically significant (p<0.05). The levels of serum CD3+, CD4+, and CD8+ after reduction in the experimental group were significantly higher than before reduction, and the difference was statistically significant (p<0.05). CD19+ level was significantly lower than before reduction, and the difference was statistically significant (p<0.05). There was no significant difference in changes of other indicators.
Manipulative reduction combined with air enema reduction can relieve pain and air injection pressure during enema, reduce reperfusion injury caused by intestinal ischemia, and protect intestinal mucosal immune function, which is a favored treatment.
探讨手法复位联合空气灌肠对小儿肠套叠肠道黏膜免疫功能的影响。
本研究为前瞻性随机对照研究，选取2018年10月至2019年10月在河北省儿童医院收治的60例原发性肠套叠患儿作为研究对象。将其随机分为两组。实验组30例患儿采用手法复位及空气灌肠复位，对照组30例患儿仅采用空气灌肠复位。记录并分析灌肠时的疼痛评分及压力。抽取实验组患儿复位前空腹血检测血清T淋巴细胞亚群CD3 +、CD4 +、CD8 +水平，B淋巴细胞亚群CD19 +水平，NK细胞亚群CD56 +水平。其中，28例复位成功患儿于复位后次日清晨再次抽取空腹血，分析复位前后各免疫细胞亚群指标。2例复位失败患儿不再检测这些指标。
实验组28例患儿复位成功，2例复位失败患儿改行开腹手术（28/30）。对照组25例患儿复位成功，5例改行开腹手术（25/30）。两组复位成功率差异无统计学意义（p>0.05）。复位后密切观察12~24h，发现患儿均无腹膜炎体征。观察组疼痛评分及复位压力低于对照组，差异有统计学意义（p<0.05）。实验组复位后血清CD3 +、CD4 +、CD8 +水平明显高于复位前，差异有统计学意义（p<0.05）。CD19 +水平明显低于复位前，差异有统计学意义（p<0.05）。其他指标变化差异无统计学意义。
手法复位联合空气灌肠复位可减轻灌肠时的疼痛及注气压力，减少肠缺血所致的再灌注损伤，保护肠道黏膜免疫功能，是一种值得推广的治疗方法。
