目的 探讨各影响因素对小儿肠套叠空气灌肠整复失败的预测价值。 方法 回顾性分析2012年1月~2019年12月武汉儿童医院收治的肠套叠患儿临床资料，包括性别、年龄、病程、阵发性哭吵/腹痛、血便、呕吐、发热、腹泻、腹部包块、住院时间、肠梗阻、套叠影位置、肠套叠类型、空气灌肠整复、手术治疗情况等。单因素分析采用Mann-Whitney U检验或卡方检验，二元logistic回归分析确定独立影响因素，ROC曲线分析各因素预测整复失败的价值。 结果 年龄、病程≥48 h、阵发性哭吵/腹痛、血便、呕吐、发热、腹泻、腹部包块、肠梗阻、套叠影位于左半结肠及住院时间在整复成功组和失败组间差异均有统计学意义（均P<0.05）。性别分布在两组间差异无统计学意义（P>0.05）。回归分析显示年龄是整复失败的保护因素，而病程时间≥48 h、血便、呕吐、发热、腹部包块、肠梗阻及套叠影位于左半结肠是危险因素。ROC曲线分析显示套叠影位于左半结肠、年龄、血便及肠梗阻均有一定预测准确性，其中年龄最佳截断点为10.5个月；肠梗阻、血便、年龄及套叠影位于左半结肠联合预测可提高准确性。 结论 年龄≤10.5个月、血便、肠梗阻及套叠影位于左半结肠预测整复失败均有一定准确性，联合预测准确性更高。
Abstract
Objective To explore the value of various influencing factors in predicting air enema failure in children with intussusception. Methods Clinical data of children with intussusception admitted to Wuhan Children's Hospital from January 2012 to December 2019 were retrospectively analyzed, including gender, age, duration of disease, paroxysmal crying or abdominal pain, bloody stool, vomiting, fever, diarrhea, abdominal mass, hospital stay, intestinal obstruction, intussusception position, intussusception type, and results of air enema and surgery treatment. Mann-Whitney U test or Chi-square test was used in univariate analysis. Independent influencing factors were determined by binary logistic regression analysis, and the value of various factors to predict the enema failure was analyzed by the AUC value of the ROC curve. Results There were statistical differences in age, duration of disease ≥ 48h, paroxysmal crying or abdominal pain, bloody stool, vomiting, fever, diarrhea, abdominal mass, intestinal obstruction, intussusception located in the left colon and hospitalization time between the successful and failed groups (P<0.05). There was no statistical difference in the gender distribution between the two groups (P>0.05). Regression analysis result showed that age was a protective factor for enema failure, while the duration of disease≥48 h, blood stool, vomiting, fever, abdominal mass, intestinal obstruction, and intussusception in the left colon were risk factors. ROC analysis result showed that intussusception located in the left colon, age, blood stool, and intestinal obstruction had certain predictive accuracy; and the best cut-off point for age was 10.5 months. Joint prediction with intestinal obstruction, bloody stool, age, and intussusception located in the left colon could improve the accuracy. Conclusions Age≤10.5 months, blood stool, intestinal obstruction, and intussusception located in the left colon have certain accuracy in predicting enema failure, and the accuracy will be higher when joint prediction.
关键词
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小儿肠套叠 /
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空气灌肠 /
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整复失败 /
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影响因素 /
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预测
Key words
Pediatric intussusception /
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Air enema /
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Enema failure /
Influencing factors /
Prediction
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参考文献
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基金
武汉市卫生健康委医学科研项目（WX21Z71）
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