Chen Yang,Xie Xiaolong,Wang Qi,et al.Influencing factors of parental selections of non-surgical interventions for acute pediatric intussusception[J].Journal of Clinical Pediatric Surgery,2020,19(08):734-740.[doi:10.3969/j.issn.1671-6353.2020.08.014]
肠套叠患儿家长选择压力性灌肠复位方式的影响因素分析
- Title:
- Influencing factors of parental selections of non-surgical interventions for acute pediatric intussusception
- Keywords:
- Intussusception; Enema; Factor Analysis; Statistical; Treatment Outcome; Child
- 分类号:
- R574.3;R452
- 摘要:
- 目的 分析影响急性肠套叠患儿家长选择X线监测下空气灌肠或超声监测下水灌肠复位方式的相关因素。方法 对2018年12月至2020年4月由四川大学华西医院小儿外科进行X线监测下空气灌肠（X-ray guided pneumatic reduction，XGPR）或超声监测下水灌肠（ultrasound guided hydrostatic reduction，USGHR）复位治疗的肠套叠患儿家长进行问卷调查。调查内容包括患儿及家长的基本情况，保险信息，患儿的症状、体征及既往治疗情况，复位情况，灌肠复位后并发症，患儿家长在选择不同压力性灌肠复位方式时的考虑因素等，分析影响患儿家长选择不同治疗方式的因素。结果 本研究共收集440份有效问卷，XGPR组158份，USGHR组282份。单因素分析发现与选择USGHR相关的因素包括：家长学历、家庭月收入、担心辐射损伤、考虑治疗费用、考虑可能发现造成肠套叠的继发性病因。进一步行多因素分析，发现影响患儿家长选择USGHR的因素是患儿家长拥有本科（大专）或以上学历（OR=1.747，P=0.022）、家庭月收入5 000元以上（OR=3.657，P<0.001）、担心辐射损伤（OR=4.182，P<0.001）、考虑可能发现造成肠套叠的继发性病因（OR=2.163，P=0.001）。结论 患儿家长拥有本科（大专）或以上学历、家庭月收入5 000元以上、担心辐射损伤、考虑可能发现造成肠套叠的继发性病因是影响肠套叠患儿家长选择USGHR的因素。
- Abstract:
- Objective To explore the influencing factors of parental selections of non-surgical interventions of X-ray guided pneumatic reduction or ultrasound guided hydrostatic reduction for acute intussusception. Methods From December 2018 to April 2020, a questionnaire survey was conducted among parents of children with acute intussusception undergoing X-ray guided pneumatic reduction or ultrasound guided hydrostatic reduction. The investigation content included the basic characteristics of children and their parents, health insurance of the patient, the symptoms, signs and previous treatments, reduction status;post-procedural complications and the factors considered by parents when choosing different non-surgical treatments. Then the influencing factors of parental selections were analyzed. Results A total of 440 valid questionnaires were collected. There were X-ray guided pneumatic reduction group (n=158) and ultrasound guided hydrostatic reduction group (n=282). In univariable model, factors associated with ultrasound guided hydrostatic reduction included:parental education level, monthly household income, concerns of radiation effects, concerns of cost and consideration of the possibility of discovering the primary cause of intussusception. And multivariable analysis revealed that the factors associated with ultrasound guided hydrostatic reduction were bachelor degree (junior college) or above (OR=1.747, P=0.022), monthly household income >5000 yuan (OR=3.657, P<0.001), concerns about potential radiation exposure (OR=4.182, P<0.001) and consideration of the possibility of discovering the primary cause of intussusception. (OR=2.163, P=0.001). Conclusion Bachelor degree (junior college) or above, monthly household income > 5000 yuan, concerns about potential radiation exposure, consideration of the possibility of discovering the primary cause of intussusception are the influencing factors for parental selection of ultrasound guided hydrostatic reduction.
参考文献/References:
1 Ein SH,Stephens CA.Intussusception:354 cases in 10 years[J].J Pediatr Surg,1971,6(1):16-27.DOI:10.1016/0022-3468(71)90663-4.
2 Ahmad MM,Wani MD,Dar HM,et al.An experience of ultrasound-guided hydrostatic reduction of intrussusception at a tertiary care centre[J].S Afr J Surg,2016,54(1):10-13.
3 Flaum V,Schneider A,Gomes Ferreira C,et al.Twenty years’ experience for reduction of ileocolic intussusceptions by saline enema under sonography control[J].J Pediatr Surg,2016,51(1):179-182.DOI:10.1016/j.jpedsurg.2015.09.022.
4 Ito Y,Kusakawa I,Murata Y,et al.Japanese guidelines for the management of intussusception in children,2011[J].Pediatr Int,2012,54(6):948-958.DOI:10.1111/j.1442-200X.2012.03622_1.x.
5 Khorana J,Patumanond J,Ukarapol N,et al.Clinical prediction rules for failed nonoperative reduction of intussusception[J].Ther Clin Risk Manag,13(12):1411-1416.DOI:10.2147/TCRM.S115253.
6 Bekdash B,Marven SS,Sprigg A.Reduction of intussusception:defining a better index of successful non-operative treatment[J].Pediatr Radiol,43(6):649-656.DOI:10.1007/s0024-012-2552-6.
7 Daneman A,Alton DJ,Ein S,et al.Perforation during attempted intussusception reduction in children-a comparison of perforation with barium and air[J].Pediatr Radiol,1995,25(2):81-88.DOI:10.1007/BF02010311.
8 Palder SB,Ein S,Stringer D,et al.Intussusception:barium or air?[J].J Pediatr Surg,26(3):271-274.DOI:10.1016/0022-3468(91)90501-j.
9 Daneman A,Alton DJ.Intussusception.Issues and controversies related to diagnosis and reduction[J].Radiol Clin North Am,1996,34(4):743-756.DOI:10.1007/s001170050115.
10 Margarit Mallol J,Ribó Cruz JM,Martín Hortiguela ME,et al.Acute intestinal invagination:hydrostatic reduction vs.pneumatic reduction[J].An Esp Pediatr,1993,38(1):17-19.
11 Xie XL,Wu Y,Wang Q,et al.A randomized trial of pneumatic reduction versus hydrostatic reduction for intussusception in pediatric patients[J].J Pediatr Surg,2018,53(8):1464-1468.DOI:10.1016/j.jpedsurg.2017.08.005.
12 Xie XL,Wu Y,Wang Q,et al.Risk factors for recurrence of intussusception in pediatric patients:A retrospective study[J].J Pediatr Surg,2018,53(11):2307-2311.DOI:10.1016/j.jpedsurg.2018.03.023.
13 胡章春,谭亚兰,郭万亮,等.儿童继发性肠套叠发病原因及治疗效果的研究[J].临床小儿外科杂志,2018,17(3):197-201.DOI:10.3969/j.issn.1671-6353.2018.03.008.Hu ZC,Tan YL,Guo WL,et al.Study of etiologies and therapeutic outcomes of secondary intussusception in children[J].J Clin Ped Sur,2018,17(3):197-201.DOI:10.3969/j.issn.1671-6353.2018.03.008.
14 Wang Q,Luo MQ,Xie XL,et al.Can intussusceptions of small bowel and colon be transient? A prospective study[J].Eur J Pediatr,2019,178(10):1537-1544.DOI:10.1007/s00431-019-03455-z.
15 Xie XL,Wu Y,Wang Q,et al.Risk factors for failure of hydrostatic reduction of intussusception in pediatric patients:A retrospective study[J].Medicine (Baltimore),2019,98(1):e13826.DOI:10.1097/MD.0000000000013826.
16 胡思佳,白玉作.空气灌肠复位与水压灌肠复位治疗小儿肠套叠研究进展[J].临床小儿外科杂志,2018,17(1):66-72.DOI:10.3969/j.issn.1671-6353.2018.01.016.Hu SJ,Bai YZ.Recent advances in the treatment of pneumatic versus hydrostatic reduction for intussusception in children[J].J Clin Ped Sur,2018,17(1):66-72.DOI:10.3969/j.issn.1671-6353.2018.01.016.
17 Kinsella N,Stattin P,Cahill D,et al.Factors influencing men’s choice of and adherence to active surveillance for low-risk prostate cancer:a mixed-method systematic review[J].Eur Urol,2018,74(3):261-280.DOI:10.1016/j.eururo.2018.02.026.
18 Nordenvall R,Marcano AI,Adami J,et al.The effect of socioeconomic status on the choice of treatment for patients with cruciate ligament injuries in the knee:a population-based cohort study[J].Am J Sports Med,2017,45(3):535-540.DOI:10.1177/0363546516672651.
19 Youm J,Chan V,Belkora J,et al.Impact of socioeconomic factors on informed decision making and treatment choice in patients with hip and knee OA[J].J Arthroplasty,2015,30(2):171-175.DOI:10.1016/j.arth.2014.09.006.
20 胡小素,苏垠平,孙全富.儿童辐射效应及其医疗照射防护的进展[J].中国辐射卫生,2017,26(1):119-122.DOI:10.3969/j.issn.1004-714X.2017.01.043.Hu XS,Su YP,Sun QF.Recent advances in radiation effects and medical irradiation protections in children[J].Chinese Journal of Radiological Health,2017,26(1):119-122.DOI:10.3969/j.issn.1004-714X.2017.01.043.
21 Heenan SD,Kyriou J,Fitzgerald M,et al.Effective dose at pneumatic reduction of paediatric intussusception[J].Clin Radiol,2000,55(11):811-816.DOI:10.1053/crad.2000.0481.
22 Verschelden P,Filiatrault D,Garel L,et al.Intussusception in children:reliability of US in diagnosis-a prospective study[J].Radiology,1992,184(3):741-744.DOI:10.11 48/radiology.184.3.1509059.
23 Navarro O,Dugougeat F,Kornecki A,et al.The impact of imaging in the management of intussusception owing to pathologic lead points in children.A review of 43 cases[J].Pediatr Radiol,2000,30(9):594-603.DOI:10.1007/s002470000261.
相似文献/References:
[1]吴臻斐陈聪德林进汉刘平李仲荣陈肖鸣.小儿急性肠套叠肠坏死相关因素分析[J].临床小儿外科杂志,2011,10(01):0.
[2]洪淳,俞钢,杨琳琳,等.B超引导下水压灌肠复位治疗小儿急性肠套叠280例[J].临床小儿外科杂志,2008,7(02):29.
[3]袁中生.彩超监视下水压灌肠治疗小儿肠套叠36例[J].临床小儿外科杂志,2007,6(01):35.
[4]李良波 刘自光 黄茂伦 甄国志 谢芬 王春强 冯立文.Cajal间质细胞与肠套叠关系的探讨[J].临床小儿外科杂志,2011,10(03):202.
[J].Journal of Clinical Pediatric Surgery,2011,10(08):202.
[5]黄圣余 曾玉英 张清姬 林福贞 吴善苏 阮海燕 林秀银 陈勇斌. 经肛门结肠灌洗一期治疗小儿肠套叠左半结肠坏死的体会[J].临床小儿外科杂志,2011,10(06):474.
[J].Journal of Clinical Pediatric Surgery,2011,10(08):474.
[6]周良 侯广军 耿宪杰 张春英 黄华. 小儿过敏性紫癜并发肠套叠的诊断与治疗[J].临床小儿外科杂志,2012,11(04):315.
[J].Journal of Clinical Pediatric Surgery,2012,11(08):315.
[7]张冬 易军 邵雷. 复合麻醉下空气灌肠治疗难复型肠套叠[J].临床小儿外科杂志,2012,11(05):393.
[J].Journal of Clinical Pediatric Surgery,2012,11(08):393.
[8]李忠,周旭坤,邓立军,等.全麻下再次空气灌肠治疗难复性小儿肠套叠16例[J].临床小儿外科杂志,2013,12(03):250.[doi:10.3969/j.issn.1671—6353.2013.03.029]
[9]何纯刚 邓洪强 吴东波. 小儿肠套叠空气灌肠整复术252例分析[J].临床小儿外科杂志,2014,13(04):359.
[10]苏真伟 李坪. 手术治疗小儿急性肠套叠53例[J].临床小儿外科杂志,2014,13(06):562.
[11]李欢,汪昕,杨虎,等.水压灌肠与空气灌肠复位治疗小儿原发性肠套叠单中心949例回顾性研究[J].临床小儿外科杂志,2023,22(10):988.[doi:10.3760/cma.j.cn101785-202203072-016]
Li Huan,Wang Xin,Yang Hu,et al.Ultrasound-guided hydrostatic reduction versus fluoroscopy-guided air reduction for pediatric primary intussusception: a single-center retrospective study of 949 cases[J].Journal of Clinical Pediatric Surgery,2023,22(08):988.[doi:10.3760/cma.j.cn101785-202203072-016]
备注/Memo
收稿日期:2020-05-09。
基金项目:四川省科技厅项目（编号：2020YFS0108）
通讯作者:向波,Email:xb_scu.edu@hotmail.com