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

Influencing factors of parental selections of non-surgical interventions for acute pediatric intussusception

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5000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5000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。

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.