Nuutinen M, Uhari M, Karvali T, Kouvalainen K
Department of Pediatrics, University of Oulu, Finland.
Acta Paediatr. 1994 Nov;83(11):1200-5. doi: 10.1111/j.1651-2227.1994.tb18281.x.
A retrospective analysis of 98 patients, less than 15 years of age, treated for caustic ingestion during 1976-1990 was performed to evaluate the modern consequences of caustic ingestion in children and to set indications for esophagoscopies and radiographic and laboratory examinations. Dishwasher detergents were ingested by 56 children. There were no lye ingestions, since lye has not been freely available in Finland since 1969. Household acetic acid (vinegar) was the most commonly (12/23) ingested acid. Primary esophagoscopy was performed in 79 of the 98 cases (80.6%). Esophageal burns were found in 20 patients. Acids caused burns more often than alkalies (9/23 (39.1%) versus 11/75 (14.7%); p = 0.011; 95% confidence intervals (CI) for the difference 5.6-43.3%) and acid burns more often developed into scars (7.4% versus 4%; p = 0.029; 95% CI for the difference 1.4-25.4%). The only esophageal stricture developed after ingestion of a Clinitest tablet. The mean time for hospitalization as a result of acid ingestion was significantly longer than after alkaline ingestion (3.2 (SD 3.5) days, n = 23 versus 1.5 (1.6) days, n = 75; p < 0.05; 95% CI for the difference 0.7-2.8 days). Prolonged drooling and dysphagia (12-24 h) predicted esophageal scar formation with 100% sensitivity and 90.1% specificity, but signs and symptoms did not predict esophageal burns after primary esophagoscopy. Radiographic examinations and leukocyte counts were of no value in predicting esophageal burns and scars. The panorama of caustic ingestion appears to have changed, probably due in part to the law banning sale of lye products since 1969. This type of law should be encouraged elsewhere. Acids cause even more caustic burns than alkalies. Vinegar should be regarded as a potent caustic substance and distributed in baby-safe bottles with appropriate information on its caustic nature. As severe esophageal lesions after accidental ingestion of caustic substances are now rare in children, primary esophagoscopies and hospitalization of patients are not indicated routinely. The decision on esophagoscopy can be made on the basis of drooling and dysphagia during follow-up.
对1976年至1990年间接受腐蚀性物质摄入治疗的98名15岁以下儿童进行了回顾性分析，以评估儿童腐蚀性物质摄入的现代后果，并确定食管镜检查、影像学检查和实验室检查的指征。56名儿童摄入了洗碗机洗涤剂。由于自1969年以来芬兰已不再自由销售碱液，因此没有碱液摄入病例。家用醋酸（醋）是最常被摄入的酸（12/23）。98例中有79例（80.6%）进行了初次食管镜检查。发现20例患者有食管烧伤。酸比碱更易导致烧伤（9/23（39.1%）对11/75（14.7%）；p = 0.011；差异的95%置信区间（CI）为5.6 - 43.3%），且酸烧伤更易发展为瘢痕（7.4%对4%；p = 0.029；差异的95%CI为1.4 - 25.4%）。唯一的食管狭窄是在摄入尿糖试纸片后发生的。因酸摄入导致的平均住院时间显著长于碱摄入后（3.2（标准差3.5）天，n = 23对1.5（1.6）天，n = 75；p < 0.05；差异的95%CI为0.7 - 2.8天）。持续流口水和吞咽困难（12 - 24小时）对食管瘢痕形成的预测敏感性为100%，特异性为90.1%，但初次食管镜检查后的体征和症状并不能预测食管烧伤。影像学检查和白细胞计数对预测食管烧伤和瘢痕没有价值。腐蚀性物质摄入的情况似乎已经发生了变化，这可能部分归因于自1969年以来禁止销售碱液产品的法律。其他地方应鼓励制定此类法律。酸比碱更易导致腐蚀性烧伤。应将醋视为一种强效腐蚀性物质，并以儿童安全瓶包装，附上有关其腐蚀性的适当信息。由于儿童意外摄入腐蚀性物质后严重食管病变现在很少见，因此不常规建议进行初次食管镜检查和患者住院治疗。食管镜检查的决定可根据随访期间的流口水和吞咽困难情况做出。
