李文

·短篇論著·

復(fù)方冬眠靈合劑對(duì)小兒嵌頓疝手法復(fù)位的影響

李文

目的探討復(fù)方冬眠靈合劑在小兒嵌頓疝手法復(fù)位中的應(yīng)用效果。方法284例腹股溝嵌頓疝患兒,隨機(jī)分為實(shí)驗(yàn)組(144例)和對(duì)照組(140例)。實(shí)驗(yàn)組采用復(fù)方冬眠靈合劑配合常規(guī)手法復(fù)位治療,對(duì)照組僅用常規(guī)手法復(fù)位治療。再將對(duì)照組中未復(fù)位成功的19例患兒隨機(jī)分為A組(9例)和B組(10例),A組復(fù)位失敗后讓其抬高臀部休息1～2 h后再行常規(guī)手法復(fù)位,B組復(fù)位失敗后肌內(nèi)注射復(fù)方冬眠靈合劑,抬高臀部1～2 h后再行手法復(fù)位。對(duì)比各組效果。結(jié)果實(shí)驗(yàn)組復(fù)位成功率為95.14%,高于對(duì)照組的86.43%(P＜0.05)。B組復(fù)位成功率為90.00%,高于A組的44.44%(P＜0.05)。結(jié)論小兒嵌頓疝在手法復(fù)位中成功率較高,在復(fù)方冬眠靈合劑輔助下復(fù)位成功率更高,降低了患兒痛苦及家屬的焦慮,提高了小兒嵌頓疝手法復(fù)位的成功率,副作用或并發(fā)癥發(fā)生率低,降低了患兒急診手術(shù)的比例。

小兒嵌頓疝；復(fù)方冬眠靈合劑 ；手法復(fù)位

小兒嵌頓疝是指當(dāng)疝環(huán)較小而腹內(nèi)壓驟增時(shí),疝內(nèi)容物可強(qiáng)行擴(kuò)張囊頸而進(jìn)入疝囊,隨后因囊頸的彈性回縮將內(nèi)容物卡住,使其不能回納［1］。疝內(nèi)容物是進(jìn)入疝囊的腹內(nèi)器官或組織,小腸最為多見(jiàn),其次是大網(wǎng)膜,也可以是盲腸、闌尾或乙狀結(jié)腸等。若嵌頓內(nèi)容物為腸管,會(huì)出現(xiàn)腹痛、惡心、嘔吐、厭食、哭鬧或煩躁不安,小兒嵌頓疝是小兒外科常見(jiàn)急癥之一,如處理不及時(shí),疝內(nèi)容物可能發(fā)生絞窄、壞死,出現(xiàn)腹膜炎、多器官功能障礙綜合征(MODS),甚至死亡,因此,一旦診斷明確,應(yīng)及時(shí)處理。本文探討復(fù)方冬眠靈合劑在小兒嵌頓疝手法復(fù)位中的應(yīng)用效果,報(bào)告如下。

1 資料與方法

1.1一般資料 選取本院2015年1月～ 2016年5月門(mén)診及收治入科的284例腹股溝嵌頓疝患兒,隨機(jī)分為對(duì)照組(140例)和實(shí)驗(yàn)組(144例),均為單側(cè)嵌頓疝。實(shí)驗(yàn)組,男141例,女3例,年齡2個(gè)月～2.2歲,平均年齡1.2歲,嵌頓時(shí)間0.5～9.0 h,平均時(shí)間4.1 h；對(duì)照組,男139例,女1例,年齡4個(gè)月～1.8歲,平均年齡1.1歲,嵌頓時(shí)間0.6～8.7 h,平均時(shí)間3.9 h。將對(duì)照組中未復(fù)位成功的19例患兒隨機(jī)分為A組(9例),年齡3個(gè)月～1.8歲,平均年齡1.1歲,平均嵌頓時(shí)間4.3 h；B組(10例),年齡4個(gè)月～1.5歲,平均年齡0.9歲,平均嵌頓時(shí)間4.4 h。各組患兒一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05),具有可比性。

1.2方法 對(duì)照組：墊高患兒臀部,使腰骶部與床面呈50°左右,患兒家屬一人固定其上身,一人固定其下身,并使患兒雙腿外展,術(shù)者左手輕柔的按摩外環(huán)處,以減輕局部水腫,使肌肉松弛,然后在外環(huán)處用拇指及食指固定疝蒂,右手輕輕擠壓疝內(nèi)容物,均勻地持續(xù)加壓,如患兒哭鬧,腹內(nèi)壓增加時(shí),右手持續(xù)不減,當(dāng)小兒吸氣的瞬間腹壓降低時(shí),再行復(fù)位,復(fù)位后常有少量氣體通過(guò)的感覺(jué),然后疝塊消失,有時(shí)還可聽(tīng)到“咕?！甭?。復(fù)位過(guò)程中應(yīng)注意力量適中,不能盲目強(qiáng)行復(fù)位。實(shí)驗(yàn)組：復(fù)位前先肌內(nèi)注射復(fù)方冬眠靈合劑1 mg/kg(異丙嗪及氯丙嗪各1 mg/kg),待2～3 h患兒鎮(zhèn)靜后再行手法復(fù)位。A組患兒復(fù)位失敗后讓其抬高臀部休息1～2 h后再行手法復(fù)位；B組復(fù)位失敗后則肌內(nèi)注射復(fù)方冬眠靈合劑,抬高臀部1～2 h后再行手法復(fù)位。

1.3統(tǒng)計(jì)學(xué)方法 采用SPSS18.0統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(±s)表示,采用t檢驗(yàn)；計(jì)數(shù)資料以率(%)表示,采用χ2檢驗(yàn)。P＜0.05表示差異具有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

2.1對(duì)照組和實(shí)驗(yàn)組復(fù)位成功情況比較 實(shí)驗(yàn)組復(fù)位成功率為95.14%,高于對(duì)照組的86.43%,差異具有統(tǒng)計(jì)學(xué)意義(χ2=6.476,P＜0.05)。見(jiàn)表1。

表1 對(duì)照組和實(shí)驗(yàn)組復(fù)位成功情況比較(n,%)

2.2A組和B組復(fù)位成功情況比較 B組復(fù)位成功率為90.00%,高于A組的44.44%,差異具有統(tǒng)計(jì)學(xué)意義(χ2=4.550,P＜0.05)。見(jiàn)表2。

表2 A組和B組復(fù)位成功情況比較 (n,%)

3 討論

在復(fù)方冬眠靈合劑的輔助作用下,嵌頓的疝囊由大變小,張力也在持續(xù)降低,在此情況下行嵌頓疝手法復(fù)位有以下優(yōu)點(diǎn)：①?gòu)?fù)位成功率提高；②復(fù)位所用時(shí)間減少；③患兒痛苦減輕；④部分病例無(wú)需手法復(fù)位,疝塊也可自行還納。小兒嵌頓疝多見(jiàn)于2歲以?xún)?nèi)患兒,對(duì)于1歲以?xún)?nèi)的患兒,腹股溝疝有自愈的可能,但如果疝反復(fù)嵌頓,應(yīng)及早進(jìn)行手術(shù)。復(fù)位成功者,可待24～48 h后疝囊及其周?chē)M織水腫消退再行擇期手術(shù)［2］,對(duì)于8個(gè)月以上患兒可選擇在腹腔鏡下行疝囊高位結(jié)扎術(shù),腹腔鏡手術(shù)優(yōu)于傳統(tǒng)手術(shù)［3-5］：在腹腔鏡視野下,可看見(jiàn)對(duì)側(cè)疝囊情況,對(duì)于另一側(cè)未曾被發(fā)現(xiàn)的斜疝,可一并行疝囊高位結(jié)扎,創(chuàng)傷小,手術(shù)時(shí)間短,恢復(fù)快,并發(fā)癥少,復(fù)發(fā)率低。手法復(fù)位只是一種臨時(shí)急救措施,大部分患兒會(huì)反復(fù)發(fā)作,因此,對(duì)于復(fù)位成功患兒,建議其家屬在院觀察0.5 h,無(wú)并發(fā)癥的情況下,回家待患兒水腫消退,無(wú)感冒、咳嗽、發(fā)熱、流涕等呼吸道感染癥狀的情況下,選擇擇期手術(shù)。若嵌頓疝無(wú)法復(fù)位,需在急診下行傳統(tǒng)疝囊高位結(jié)扎術(shù)［6,7］。

本研究選取284例腹股溝嵌頓疝患兒,隨機(jī)分為實(shí)驗(yàn)組(144例)和對(duì)照組(140例)。實(shí)驗(yàn)組采用復(fù)方冬眠靈合劑配合常規(guī)手法復(fù)位治療,對(duì)照組僅用常規(guī)手法復(fù)位治療。再將對(duì)照組中未復(fù)位成功的19例患兒隨機(jī)分為A組(9例)和B組(10例),A組復(fù)位失敗后讓其抬高臀部休息1～2 h后再行常規(guī)手法復(fù)位,B組復(fù)位失敗后肌內(nèi)注射復(fù)方冬眠靈合劑,抬高臀部1～2 h后再行手法復(fù)位。結(jié)果顯示,實(shí)驗(yàn)組復(fù)位成功率為95.14%,高于對(duì)照組的86.43%,差異具有統(tǒng)計(jì)學(xué)意義(χ2=6.476,P＜0.05)。B組復(fù)位成功率為90.00%,高于A組的44.44%,差異具有統(tǒng)計(jì)學(xué)意義(χ2=4.550,P＜0.05)。

綜上所述,復(fù)方冬眠靈合劑可提高小兒嵌頓疝手法復(fù)位的成功率,副作用或并發(fā)癥發(fā)生率低,降低小兒急診手術(shù)的比例,值得推廣。

［1］曹偉新.外科護(hù)理學(xué).第4版.北京:人民衛(wèi)生出版社,2008: 28.

［2］Koivusalo A,Pakarinen MP,Rintala RJ.Laparoscopic herniorrhaphy after manual reduction of incarcerated inguinal hernia.Surg Endosc,2007,21(12):2147.

［3］吳志揚(yáng),馬德奎,曾海峰,等.小兒腹股溝斜疝腹腔鏡與開(kāi)放手術(shù)的對(duì)比研究.中國(guó)內(nèi)鏡雜志,2007,13(7):749-750.

［4］婁鋒.區(qū)域神經(jīng)阻滯在小兒嵌頓疝手法復(fù)位中的應(yīng)用.淮海醫(yī)藥,2008,26(1):42-43.

［5］黃永,張冬.小兒嵌頓性腹股溝疝手法復(fù)位的影響因素研究.右江民族醫(yī)學(xué)院學(xué)報(bào),2014(5):756-757.

［6］王笑軍.小兒腹股溝嵌頓疝手法復(fù)位86例分析.世界最新醫(yī)學(xué)信息文摘(連續(xù)型電子期刊),2015(33):49.

［7］李新.小兒嵌頓疝手法復(fù)位的臨床分析.中國(guó)醫(yī)藥指南,2013(24):466-467.

Influence by compound wintermin mixture on manipulative reduction of pediatric incarcerated hernia

LI Wen.Department of Pediatrics,First Affiliated Hospital of Southwest Medical University,Luzhou 646000,China

ObjectiveTo investigate application effect by compound wintermin mixture in manipulative reduction of pediatric incarcerated hernia.MethodsA total of 284 children with inguinal incarcerated hernia were randomly divided into experimental group (144 cases) and control group (140 cases).The experimental group received compound wintermin mixture combined with conventional manipulative reduction for treatment,and the control group received conventional manipulative reduction alone.19 unsuccessful reduction cases in the control group were further randomly divided into group A (9 cases) and group B (10 cases).Group A received conventional manipulative reduction after 1～2 h rest by raising hip due to failed reduction,and group B received conventional manipulative reduction after intramuscular injection of compound wintermin mixture and 1～2 h rest by raising hip due to failed reduction.Effects in all groups were compared.ResultsThe experimental group had high successful reduction rate as 95.14% than 86.43% of the control group(P＜0.05).Group B had higher successful reduction rate as 90.00% than 44.44% of group A(P＜0.05).ConclusionManipulative reduction shows high success rate for pediatric incarcerated hernia,while its combination with compound wintermin mixture provides much higher success rate.This method reduce pain in children and anxiety in family members,improve success rate of manipulative reduction for pediatric incarcerated hernia,and lower incidences of side effects or complication,and decrease proportion of children receiving emergency operation.

Pediatric incarcerated hernia; Compound wintermin mixture; Manipulative reduction

10.14164/j.cnki.cn11-5581/r.2016.17.010

2016-07-05］

646000 西南醫(yī)科大學(xué)附屬第一醫(yī)院兒外科