Analysis of risk factors for early recurrence of pediatric intussusception after ultrasound-guided warm saline enema reduction
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摘要:
目的 探讨彩超监控引导温盐水灌肠复位术治疗小儿肠套叠后早期复发的独立危险因素，为临床优化治疗策略提供依据。 方法 采用回顾性队列研究设计，纳入2018年12月—2024年12月蚌埠医科大学第一附属医院收治的209例急性肠套叠患儿。所有病例均经超声确诊并接受彩超引导下温盐水灌肠复位治疗。记录患儿发病时间、脱水状态、套叠部位及类型等临床资料，采用单因素和多因素logistic回归模型分析复位后48 h内复发的独立危险因素。 结果 194例(92.82%)复位成功，15例(7.18%)于48 h内复发。多因素分析显示，发病时间＞24 h(OR=3.168，95% CI：1.570~6.393，P=0.001)、脱水状态(OR=5.324，95% CI：1.090~26.012，P=0.039)、原始套头位于脾曲及降结肠以远(OR=6.951，95% CI：1.519~31.813，P=0.012)及回回结型套叠(OR=3.848，95% CI：1.003~14.760，P=0.049)均是复位后早期复发的独立危险因素(P < 0.05)。腹胀(OR=2.305，95% CI：0.591~8.993，P=0.229)及血便(OR=2.331，95% CI：0.585~9.297，P=0.230)不是复位后早期复发的影响因素。 结论 发病时间＞24 h、脱水、套头位于脾曲及降结肠以远、回回结型套叠是彩超引导下温盐水灌肠复位术后早期复发的危险因素。临床应针对上述因素制定个体化干预措施，包括缩短确诊至治疗时间窗、纠正脱水状态及优化复位手法，以降低复发风险。 Abstract:Objective To investigate the independent risk factors for early recurrence after ultrasound-guided warm saline enema reduction in children with intussusception, and to provide evidence for optimizing clinical treatment strategies. Methods A retrospective cohort study design was adopted, including 209 children with acute intussusception admitted to the First Affiliated Hospital of Bengbu Medical University from December 2018 to December 2024. All cases were diagnosed by ultrasound and treated with ultrasound-guided warm saline enema reduction. Clinical data such as the onset time of the disease, dehydration status, location and type of intussusception were recorded. Univariate and multivariate logistic regression model was used to analyze the independent risk factors for recurrence within 48 hours after reduction. Results Among the cases, 194 (92.82%) achieved successful reduction, while 15 (7.18%) experienced recurrence within 48 hours. Multivariate analysis revealed that duration of symptoms >24 hours (OR=3.168, 95% CI: 1.570-6.393, P=0.001), dehydration (OR=5.324, 95% CI: 1.090-26.012, P=0.039), initial intussusception head located at the splenic flexure and distal descending colon (OR=6.951, 95% CI: 1.519-31.813, P=0.012), and ileo-ileocolic type intussusception (OR=3.848, 95% CI: 1.003-14.760, P=0.049) were independent risk factors for early recurrence after reduction (all P < 0.05). Abdominal distension (OR=2.305, 95% CI: 0.591-8.993, P=0.229) and bloody stool (OR=2.331, 95% CI: 0.585-9.297, P=0.230) showed no significant association. Conclusion The key risk factors for early recurrence after ultrasound-guided warm saline enema reduction are onset time of illness >24 hours, dehydration, initial intussusception head located at the splenic flexure and beyond the descending colon, and ileo-ileal type of intussusception. Clinically, individualized interventions should be developed targeting these factors, including shortening the time window from diagnosis to treatment, correcting dehydration status, and optimizing the reduction technique, in order to reduce the risk of recurrence. -
Key words:
- Intussusception /
- Children /
- Ultrasound-guided /
- Warm saline enema /
- Recurrence
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表 1 肠套叠患者复发组与未复发组临床特征比较
Table 1. Comparison of clinical characteristics between the recurrence group and the non-recurrence group of intussusception patients
项目 复发组(n=15) 未复发组(n=194) 统计量 P值 年龄(x±s，岁) 31.00±14.64 22.13±14.47 2.286a 0.023 性别[例(%)] 0.322d 男性 13(86.67) 122(62.89) 女性 2(13.33) 72(37.11) 发病时间[例(%)] 26.120b ＜0.001 0~12 h 3(20.00) 148(76.29) 13~24 h 3(20.00) 21(10.82) >24 h 9(60.00) 25(12.89) 脱水状态[例(%)] 10.490c 0.001 是 5(33.33) 15(7.73) 否 10(66.67) 179(92.27) 腹胀程度[例(%)] 1.068c 0.301 是 7(46.67) 65(33.51) 否 8(53.33) 129(66.49) 套叠部位(脾曲及降结肠)[例(%)] 23.860c ＜0.001 是 6(40.00) 10(5.15) 否 9(60.00) 184(94.85) 套叠类型[例(%)] 11.570c 0.001 回回型 7(46.67) 26(13.40) 非回回型 8(53.33) 168(86.60) 血便[例(%)] 8.450c 0.004 是 8(53.33) 40(20.62) 否 7(46.67) 154(79.38) 注：a为t值，b为Z值，c为χ2值；d为使用Fisher精确检验。 
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表 2 各变量赋值情况
Table 2. Coding of independent variables
变量 赋值方法 发病时间 0~12 h=0，13~24 h=1，＞24 h=2 脱水 否=0，是=1 腹胀 否=0，是=1 原始套头部位于脾曲及降结肠以远 脾曲及降结肠以远=1，否=0 套叠类型 回回型=1，非回回型=0 血便 否=0，是=1 复发 否=0，是=1
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表 3 小儿肠套叠彩超引导温盐水灌肠复位成功后复发影响因素的单因素logistic回归分析
Table 3. Univariate logistic regression analysis of factors influencing recurrence after successful color ultrasound-guided warm saline enema reduction in children with intussusception
变量 B SE Waldχ2 P值 OR值 95% CI 发病时间＞24 h 1.400 0.329 18.078 ＜0.001 4.055 2.127~7.731 脱水 1.786 0.610 8.571 0.003 5.967 1.808~19.727 腹胀 0.552 0.539 1.047 0.306 1.737 0.603~4.999 原始套头位于脾曲及降结肠 2.507 0.619 16.399 ＜0.001 12.267 3.646~41.272 回回结型 1.732 0.559 9.601 0.002 5.654 1.891~16.905 血便 1.482 0.547 7.333 0.007 4.400 1.506~12.858
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表 4 小儿肠套叠彩超引导温盐水灌肠复位成功后复发影响因素的多因素logistic回归分析
Table 4. Multivariate logistic regression analysis of factors influencing recurrence after successful color ultrasound-guided warm saline enema reduction in children with intussusception
变量 B SE Waldχ2 P值 OR值 95% CI 发病时间＞24 h 1.153 0.358 10.361 0.001 3.168 1.570~6.393 脱水 1.627 0.809 4.269 0.039 5.324 1.090~26.012 腹胀 0.835 0.695 1.445 0.229 2.305 0.591~8.993 原始套头位于脾曲及降结肠 1.939 0.776 6.242 0.012 6.951 1.519~31.813 回回结型 1.348 0.686 3.860 0.049 3.848 1.003~14.760 血便 0.846 0.706 1.438 0.230 2.331 0.585~9.297
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