Upper Gastrointestinal Endoscopy in Children’s Abdominal Pains in Ivory Coast

Since a longtime considered as functional and psychological, children’s abdominal pains (CAP) is a public health problem. Advances in digestive endoscopy and Helicobacter pylori (H. pylori) discovery have reignited the debate of the organicity of CAP. The aim of this study is to determine the diagnosis rentability of upper gastrointestinal endoscopy (UGIE) in CAP in Ivory Coast. Patients and Methods: This a retrospective analytical study based on reports of UGIE performed in 2 university hospital and 3 private clinics of Abidjan from march 2007 to march 2016. The children (from 1 day to 15 years) in which UGIE were performed for abdominal pains were included in the study. Results: 116 UGIE were performed in children for abdominal pains during the study period. Epigastric pain was the main indication of UGIE (88%). The diagnosis rentability of UGIE was more than 70% in this study. The main anomalies observed in UGIE were gastropathies. Ulcers were rarely found. Conclusion: UGIE play an important diagnosis role in CAP in Ivory Coast. However gastric biopsies for Helicobacter pylori research are not common practice in our country.

Glucomannan for abdominal pain-related functional gastrointestinal disorders in children:A randomized trial

AIM:To assess the efficacy of glucomannan(GNN) as the sole treatment for abdominal pain-related functional gastrointestinal disorders(FGIDs).METHODS:We conducted a double-blind,placebocontrolled,randomized trial.Patients were recruited among children referred to the Department of Paediatrics,Medical University of Warsaw.Included in the study were children aged 7-17 years with abdominal pain-related FGIDs classified according to the Rome Ⅲ diagnostic criteria.The children were randomly assigned to receive GNN,a polysaccharide of 1,4-D-glucose and D-mannose,a soluble fiber from the Japanese Konjac plant,at a dosage of 2.52 g/d(1 sachet of 1.26 g 2 times a day),or a comparable placebo(maltodextrin) at the same dosage.The content of each sachet was dissolved in approximately 125 mL of fluid and was consumed twice daily for 4 wk.RESULTS:Of the 89 eligible children,84(94%) completed the study."No pain" and "treatment success"(defined as no pain or a decrease ≥ 2/6 points on the FACES Pain Scale Revised) were similar in the GNN(n = 41) and placebo(n = 43) groups [no pain(12/41 vs 6/43,respectively;RR = 2.1,95%CI:0.87-5.07) as well as treatment success(23/41 vs 20/43;RR = 1.2,95%CI:0.79-1.83)].No significant differences between the groups were observed in the secondary outcomes,such as abdominal cramps,abdominal bloating/gassiness,episodes of nausea or vomiting,or a changed in stool consistency.GNN demonstrated no significant influence on the number of children requiring rescue therapy,school absenteeism,or daily activities.CONCLUSION:In our setting,GNN,as dosed in this study,was no more effective than the placebo in achieving therapeutic success in the management of FGIDs in children.

Gastrointestinal contrast-enhanced ultrasonography for diagnosis and treatment of peptic ulcer in children

BACKGROUND The detection rate of peptic ulcer in children is improving,with development of diagnostic procedures.Gastroscopy is the gold standard for the diagnosis of peptic ulcer,but it is an invasive procedure.Gastrointestinal contrast-enhanced ultrasonography(CEUS)has the advantages of being painless,noninvasive,nonradioactive,easy to use,and safe.AIM To investigate the clinical value of CEUS for diagnosis and treatment of peptic ulcer in children.METHODS We investigated 43 children with digestive tract symptoms in our hospital from January 2021 to June 2022.All children were examined by routine ultrasound,gastrointestinal CEUS,and gastroscopy.The pathological results of gastroscopy were taken as the gold standard.Routine ultrasonography was performed before gastrointestinal CEUS.Conventional ultrasound showed the thickness of the gastroduodenal wall,gastric peristalsis,and the adjacent organs and tissues around the abdominal cavity.Gastrointestinal CEUS recorded the thickness of the gastroduodenal wall;the size,location and shape of the ulcer;gastric peristalsis;and adjacent organs and tissues around the abdominal cavity.The results of routine ultrasound and gastrointestinal ultrasound were compared with those of gastroscopy to evaluate the diagnostic results and coincidence rate of routine ultrasound and gastrointestinal CEUS.All children received informed consent from their guardians for CEUS.This study was reviewed and approved by the hospital medical ethics committee.RESULTS Among the 43 children,17(15 male,2 female)were diagnosed with peptic ulcer by gastroscopy.There were 26 children with nonpeptic ulcer.There were eight cases of peptic ulcer and 35 of nonpeptic ulcer diagnosed by conventional ultrasound.The diagnostic coincidence rate of peptic ulcer in children diagnosed by conventional ultrasound was 79.1%(34/43),which was significantly different from that of gastroscopy(P=0.033).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is low.Fifteen cases of peptic ulcer and 28 of nonpeptic ulcer were diagnosed by CEUS.The diagnostic coincidence rate of peptic ulcer in children was 95.3%(41/43).There was no significant difference between CEUS and gastroscopy(P=0.655).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is high.CONCLUSION Gastrointestinal CEUS has a high coincidence rate in the diagnosis of peptic ulcer in children,and can be used as a preliminary examination method.

Association between functional abdominal pain disorders and asthma in adolescents: A cross-sectional study

AIM To find the association between asthma and different types of functional abdominal pain disorders(FAPDs) among teenagers. METHOD A cross-sectional study was conducted among 13 to 15-year-old children from six randomly selected schools in Anuradhapura district of Sri Lanka. Data were collected using translated and validated selfadministered questionnaires(Rome Ⅲ questionnaire, International Study on Asthma and Allergies in Childhood questionnaire, and Pediatric Quality of Life Inventory 4.0) and administered under an examination setting after obtaining parental consent and assent.RESULTS Of the 1101 children included in the analysis, 157(14.3%) had asthma and 101(9.2%) had at least one FAPDs. Of children with asthma, 19.1% had at least one type of FAPDs. Prevalence rates of functional abdominal pain(FAP)(8.9% vs 3.3% in nonasthmatics), functional dyspepsia(FD)(2.5% vs 0.7%), and abdominal migraine(AM)(3.2% vs 0.4%) were higher in those with asthma(P < 0.05, multiple logistic regression analysis), but not in those with irritable bowel syndrome(4.5% vs 3.1%, P = 0.2). Severe abdominal pain(10.8% vs 4.6%), bloating(16.6% vs 9.6%), nausea(6.4% vs 2.9%), and anorexia(24.2% vs 16.2%) were more prevalent among asthmatics(P < 0.05). Lower gastrointestinal symptoms did not show a significant difference. Scores obtained for health related quality of life(HRQoL) were lower in those with asthma and FAPDs(P < 0.05, unpaired t-test).CONCLUSION Asthma is associated with three different types of FAPDs, namely, FD, AM, and FAP. HRQoL is significantly impaired in teenagers with asthma and FAPDs.

The importance of visualization of appendix on abdominal ultrasound for the diagnosis of appendicitis in children: A quality assessment review

BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting.METHODS:A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years.Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain.RESULTS:Data from two community hospitals indicated visualization rate of the appendix as 11.0%and 23.2%for site 1 and site 2 respectively.In cases where the ultrasound was repeated the visualization rate remains the same.A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis.The results revealed that the visualization of an appendix(P=0.52),significantly improved the diagnosis of appendicitis(z=34,P<0.001).CONCLUSION:Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis.In our study,we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound.Hence,the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.

Irritable bowel syndrome in children: Pathogenesis, diagnosis and evidence-based treatment

Irritable bowel syndrome(IBS)is the commonest cause of recurrent abdominal pain(RAP)in children in both more developed and developing parts of the world.It is defined by the RomeⅢcriteria for functional gastrointestinal disorders.It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities.It is estimated that 10%-15%of older children and adolescents suffer from IBS.IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors.The diagnosis of IBS is made based on the RomeⅢcriteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease.Once the diagnosis of IBS is made,it is important to explain to the parents(and children)that there is no serious underlying disease.This reassurance may be effective treatment in a large number of cases.Lifestyle modifications,stress management,dietary interventions and probiotics may be beneficial in some cases.Although there is limited evidence for efficacy of pharmacological therapies suchas antispasmodics and antidiarrheals;these have a role in severe cases.Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability.Further research is necessary to understand the pathophysiology and provide specific focused therapies.

Clear cell colitis: A form of microscopic colitis in children

AIM: To describe a new clinical and pathological subtype of microscopic colitis in children. METHODS: A selected group of children with abdominal pain, constipation and/or diarrhoea showing discrete or no macroscopic abnormalities on endoscopy was described. RESULTS: Multiple biopsies of colon showed large mononuclear clear cells in lamina propria of mucous membrane provided that good quality histological sections were performed and observed under a higher magnification. Otherwise, they could be misinterpreted as artefacts. Their presence in routine histology might suggest a systemic storage disease (Whipple’s disease), and neuronal intestine dysplasia. Using immunohistochemical staining and electron microscopy we confirmed their origin from CD68 positive mononuclear macrophages. CONCLUSION: The presence of large clear cells is a constant microscopic feature. Failure of transient large bowel stationary macrophages plays a role in the pathogenesis of this benign microscopic clear cell colitis, sometimes coexisting with allergy.

Gastrointestinal side effects in children with Wilson's disease treated with zinc sulphate

AIM:To investigate the side effects of a zinc sulphate therapy in a cohort of Polish pediatric patients with Wilson's disease. METHODS:We retrospectively analyzed a cohort of 53 pediatric patients with Wilson's disease treated at the Children's Memorial Health Institute in Warsaw, Poland between the years 1996 and 2011 with zinc sulphate. Patients were diagnosed with Wilson's disease according to the scoring system of Ferenci, with 49 cases confirmed by mutation analysis. Data about the dosage scheme of zinc sulphate, side effects and efficacy and toxicity of the treatment were collected and recorded in the patient's medical chart at each visit to the hospital. RESULTS:Mean age of diagnosis for the entire cohort was 10 years (range, 2.5-17 years). Duration of treatment with zinc sulfate was 83.3 wk (range, 8-344 wk). Side effects, all of gastrointestinal origin, were observed in 21 patients (40% 9 males and 12 females), irrespective of the duration of therapy. Thirteen out of 21 patients were over the age of 10 years. The most common ATP7B mutation was p.H1069Q. Esophagogastroduodenoscopy, performed in 7 patients (33.3%) suffering from persistent and severe abdominal pain, revealed gastrointestinal ulcerations or erosions with negative Helicobacter pylori tests in all subjects investigated. The above mentioned 7 patients were treated with proton pump inhibitors. Three of those experienced resolution of symptoms, whereas proton-pump inhibitors failed to alleviate symptoms of the remaining four children and conversion of therapy to D-penicillamine was needed. CONCLUSION:Zinc sulphate appears to cause significant gastrointestinal side effects, which children on therapy for Wilson's disease should be closely monitored for.

Non-responsive celiac disease in children on a gluten free diet

BACKGROUND Non-responsive celiac disease(NRCD) is defined as the persistence of symptoms in individuals with celiac disease(CeD) despite being on a gluten-free diet(GFD). There is scant literature about NRCD in the pediatric population.AIM To determine the incidence, clinical characteristics and underlying causes of NRCD in children.METHODS Retrospective cohort study performed at Boston Children’s Hospital(BCH). Children < 18 years diagnosed with CeD by positive serology and duodenal biopsies compatible with Marsh Ⅲ histology between 2008 and 2012 were identified in the BCH’s Celiac Disease Program database. Medical records were longitudinally reviewed from the time of diagnosis through September 2015. NRCD was defined as persistent symptoms at 6 mo after the initiation of a GFD and causes of NRCD as well as symptom evolution were detailed. The children without symptoms at 6 mo(responders) were compared with the NRCD group. Additionally, presenting signs and symptoms at the time of diagnosis of CeD among the responders and NRCD patients were collected and compared to identify any potential predictors for NRCD at 6 mo of GFD therapy.RESULTS Six hundred and sixteen children were included. Ninety-one(15%) met criteria for NRCD. Most were female(77%). Abdominal pain [odds ratio(OR) 1.8 95% confidence interval(CI) 1.1-2.9], constipation(OR 3.1 95%CI 1.9-4.9) and absence of abdominal distension(OR for abdominal distension 0.4 95%CI 0.1-0.98) at diagnosis were associated with NRCD. NRCD was attributed to a wide variety of diagnoses with gluten exposure(30%) and constipation(20%) being the most common causes. Other causes for NRCD included lactose intolerance(9%), gastroesophageal reflux(8%), functional abdominal pain(7%), irritable bowel syndrome(3%), depression/anxiety(3%), eosinophilic esophagitis(2%), food allergy(1%), eating disorder(1%), gastric ulcer with Helicobacter pylori(1%), lymphocytic colitis(1%), aerophagia(1%) and undetermined(13%). 64% of children with NRCD improved on follow-up.CONCLUSION NRCD after ≥ 6 mo GFD is frequent among children, especially females, and is associated with initial presenting symptoms of constipation and/or abdominal pain. Gluten exposure is the most frequent cause.

Electrocardiograms changes in children with functional gastrointestinal disorders on low dose amitriptyline

AIM: To study the effects of low dose amitriptyline on cardiac conduction in children.METHODS: Secondary analysis of data obtained from a double-blind, randomized placebo-controlled trial, evaluating low dose amitriptyline in children with a diagnosis of functional abdominal pain, functional dyspepsia, and irritable bowel syndrome according to the Rome II criteria. Children 8-17 years of age were recruited from the pediatric gastroenterology clinics of 6 tertiary care centers in the United States. The electrocardiograms(EKGs) done prior to initiation of amitrityline and 1 mo after initiation of amitriptyline were examined. The changes in cardiac conduction were evaluated in patients and controls. RESULTS: Thirty children were included in the study. There were 12 patients, ages 9-17 years of both genders, in the amitriptyline treatment group and 18 patients, ages 9-17 years of both genders, in the placebotreatment group. None of the patients had any baseline EKG abnormality. Amitriptyline use was associated with an increase in heart rate(P = 0.024) and QTc interval(P = 0.0107) as compared to pre-EKGs. Children in the placebo group were also noted to present a statistically significant increase in QTc interval(P = 0.0498). None of the patients developed borderline QTc prolongation or long-QT syndrome after they were started on amitriptyline.CONCLUSION: The study findings suggest that once patients with functional gastrointestinal disorders have been screened for prolonged QTc interval on baseline EKG, they probably do not need a second EKG for reevaluation of cardiac conduction after starting low dose amitriptyline.

谓葆颗粒联合培菲康治疗小儿功能性腹痛临床疗效及对焦虑抑郁情绪的影响

目的探讨功能性腹痛患儿应用谓葆颗粒联合培菲康治疗的疗效及对患儿焦虑抑郁情绪影响。方法共计纳入102例功能性腹痛患儿(2019年3月—2023年9月入住湖北省妇幼保健院儿童消化内科),以随机数字表法分为观察组、对照组,每组51例。对照组患儿采取培菲康治疗,观察组患儿采取谓葆颗粒联合培菲康治疗。2组患儿治疗前后的结果,包括:疗效、腹痛及食欲不振、面色苍白等症状消失时间、儿童焦虑性情绪障碍筛查量表(SCARED)、儿童抑郁障碍自评量表(DSRSC)评分、不良反应。结果对照组与观察组患儿总有效率分别为84.31%、96.08%,观察组有效率高于对照组(P<0.05);观察组患儿腹痛及食欲不振、面色苍白等症状消失时间分别为(7.86±1.96)d、(4.95±0.38)d、(3.89±0.47)d,均短于对照组患儿[(10.45±1.15)d、(5.72±0.62)d、(5.10±0.38)d,P<0.05];治疗后观察组患儿SCARED及DSRSC评分分别为(10.15±1.52)分、(9.45±1.07)分,均低于对照组患儿[(17.49±2.95)分、(14.23±1.87)分,P<0.05];对照组与观察组患儿不良反应发生率分别为3.92%、1.96%,差异无统计学意义(P>0.05)。结论谓葆颗粒联合培菲康治疗小儿功能性腹痛临床疗效良好,患儿恢复快,还可较好改善患儿不良情绪,不良反应发生率较低,安全可靠。

功能性腹痛患儿的人格特点、生活质量及其相关性研究

目的分析功能性腹痛患儿与人格特点、生活质量、家庭教养方式之间的相关性,以期为临床护理干预提供理论依据。方法选取2022年8月—2023年9月福建省儿童医院收治的功能性腹痛患儿165例(观察组)与儿童保健科体检的健康儿童165例(对照组)进行研究。采用艾森克患儿人格问卷(Eysenck personality questionnaire,EPQ)、生活质量核心量表(pediatric quality of life inventorytm,PedsQLTM 4.0)、父母教养方式问卷(egna minnen av barndoms uppfostran,EMBU)、Wong-Baker面部表情疼痛量表评分,调查其功能性腹痛患儿与人格特点、生活质量和家庭教养方式的现状,探讨其影响因素。结果观察组腹痛评分为(13.95±2.16)分,高于对照组的(3.02±1.03)分(P<0.05)。观察组艾森克患儿人格问卷测试中P、N分值高于对照组,E分值低于对照组(P<0.05)。观察组生理功能、情感功能、社会功能、学校表现及总分值均低于对照组(P<0.05)。观察组F2、F3、M2高于对照组,F1、F4、M1、M5低于对照组(P<0.05)。功能性腹痛症状积分与父母教养方式F1、M1因子呈负相关,与F3、M2呈正相关;与艾森克患儿人格因子E呈负相关,与N、P因子呈正相关;与患儿生活质量呈负相关(P<0.05)。结论功能性腹痛患儿人格特点、生活质量和家庭教养方式三者之间存在相关性,情绪不稳定、性格内向及精神质人格的患儿是发生功能性腹痛的重要因素,而不良的家庭教养方式是本病发生的诱因,进一步加重病情,降低患儿生活质量。因此临床治疗上给予药物治疗外还应注重对患儿的心理干预,评估家庭教养方式以提高生活质量。

个性化护理干预在儿童功能性腹痛护理中的应用效果分析

目的:探讨个性化护理干预在儿童功能性腹痛护理中的应用效果。方法:选取2022年4-10月滨州医学院附属医院收治的80例功能性腹痛患儿作为研究对象,使用随机数字表法分为观察组、对照组,各40例。对照组进行常规护理,观察组进行个性化护理干预。比较两组护理效果。结果:观察组护理总有效率高于对照组,差异有统计学意义(P=0.048)。护理前,两组腹痛频率、腹痛程度评分比较,差异无统计学意义(P>0.05);护理后,两组腹痛频率、腹痛程度评分低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组患儿家属护理总满意度高于对照组,差异有统计学意义(P=0.040)。结论:个性化护理干预在儿童功能性腹痛护理中的应用效果显著,能够减少患儿腹痛发作次数,减轻腹痛程度,提高患儿家属护理满意度,值得临床应用。

丁香茶辣散穴位贴敷联合小建中汤辨证治疗小儿脾胃虚寒型腹痛的效果分析

目的:分析丁香茶辣散穴位贴敷联合小建中汤辨证治疗小儿脾胃虚寒型腹痛的效果。方法:选取2021年1月—2023年1月南宁市武鸣区中医医院收治的60例脾胃虚寒型腹痛患儿作为研究对象,随机分为对照组与观察组,各30例。对照组实施小建中汤加减辨证治疗,观察组在对照组基础上应用丁香茶辣散穴位贴敷治疗。比较两组治疗效果。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.044)。治疗后,两组中医症状评分、脸谱疼痛评分法评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组不良反应总发生率低于对照组,差异有统计学意义(P=0.044)。结论:丁香茶辣散穴位贴敷联合小建中汤辨证治疗小儿脾胃虚寒型腹痛的效果较好,能够缓解疼痛及症状,且安全性好。

中药穴位贴敷联合激光治疗在小儿肠系膜淋巴结炎腹痛中的临床效果

目的探讨中药穴位贴敷联合激光治疗在小儿肠系膜淋巴结炎腹痛中的临床效果。方法选取2020年7月至2022年7月广西医科大学附属武鸣医院儿科收治的88例肠系膜淋巴结炎患儿,采用随机数字表法分为对照组与观察组,每组各44例。两组均给予常规西药治疗,观察组加用中药穴位贴敷联合激光治疗。比较两组腹痛缓解时间、腹痛消失时间及腹痛复发率。结果观察组腹痛缓解时间及腹痛消失时间均短于对照组,差异有统计学意义(P<0.05)。观察组腹痛复发率低于对照组,差异有统计学意义(P<0.05)。结论中药穴位贴敷联合激光治疗在小儿肠系膜淋巴结炎腹痛中的临床效果确切,可有效改善腹痛症状,降低腹痛复发率,值得临床推广。

儿童Peutz-Jeghers综合征二例

目的分析儿童Peutz-Jeghers综合征的临床特点,探讨临床工作中Peutz-Jeghers综合征患儿急诊手术的注意事项和诊疗经验。方法回顾分析2例Peutz-Jeghers综合征患儿的临床资料。结果1例患儿以腹痛、呕吐起病,急诊行剖腹探查,行部分十二指肠切除术,术后腹痛复发,遂行肠套叠复位术,考虑Peutz-Jeghers综合征合并肠套叠;另1例患儿以腹痛、呕吐起病,急诊行剖腹探查,术后恢复良好,考虑Peutz-Jeghers综合征合并肠套叠。结论对于皮肤粘膜黑色斑点且出现外科急腹症的患儿,应考虑Peutz-Jeghers综合征,应首先解决患儿的急腹症,尽可能保留套叠的肠段,术中切除较为明显的息肉,不做预防性息肉切除,术后依据病理检查结果和基因检测结果,定期对患儿进行全胃肠道监测和息肉切除术,提高患儿远期生活质量。

Inverted Meckel's diverticulum: Two case reports and a review of the literature

Gastrointestinal surgeons seldom encounter inverted Meckel's diverticulum in their clinical practice. We describe two cases of inverted Meckel's diverticulum. If the patient has a disease-related complication such as intussusception, as with our first case, it can be easily detected. However, if the patient has subacute or chronic symptoms, as with our second case, the diagnosis might be delayed. Regardless of the diseaserelated complication, intussusception of inverted Meckel's diverticulum can be easily managed with laparoscopic single-port surgery.

非药物疗法治疗儿童功能性腹痛的研究进展

近年来,临床上功能性腹痛患儿呈逐渐增多的趋势,随着临床医师对功能性腹痛的认知逐渐深入,该病诊断率日益增加。患儿家属及医者迫切寻求有效的治疗方式,以缓解患儿的腹痛症状、减轻该病对患儿生活及学习方面的影响。关于非药物疗法的研究不在少数,包括:针灸、推拿、穴位敷贴等中医特色治法以及认知行为调节、催眠、饮食调整等其他治疗手段;无论是作为主要治疗手段还是辅助治疗手段,临床观察及随机试验均证实了非药物干预的有效性、安全性、可行性。文章总结了适用于功能性腹痛的非药物疗法的临床价值,旨在为基层医院及家庭治疗提供借鉴意义。

基于症状管理理论的尿道下裂患儿疼痛管理方案的制定及应用

目的探讨尿道下裂患儿疼痛管理方案的应用效果。方法按住院时间将尿道下裂手术患儿分为对照组62例和观察组64例。对照组按常规诊疗程序护理;观察组实施基于症状管理理论的疼痛管理方案。比较两组患儿术后4 h中重度疼痛发生率;术后不同时间疼痛评分、患儿家属满意度和患儿并发症发生率。结果患儿术后4 h中重度疼痛发生率、术后不同时间疼痛评分观察组显著低于对照组,患儿家属满意度观察组显著高于对照组(均P<0.05);两组尿瘘发生率比较,差异无统计学意义(P>0.05)。结论疼痛管理方案的实施能有效提高尿道下裂患儿术后镇痛效果,提高患儿家属满意度。

小儿急性肠系膜淋巴结炎的中医研究进展

小儿急性肠系膜淋巴结炎又称Brennemann综合征,多因病毒感染胃肠引起,极少数由细菌感染或虫毒寄生引发,亦可继发于上呼吸道感染,表现为腹痛,部位以右下腹及脐周多见,有压痛,无反跳痛,疼痛性质可包括隐痛、钝痛、胀痛、痉挛性疼痛,时发时止、时轻时重。目前西医主要采用抗炎解痉止痛等对症治疗,但本病易反复发作,病程长,患儿依从性差,若病情迁延,常致慢性再发性腹痛,进而导致食欲不振,发生贫血、营养不良,严重影响儿童的生长发育。中医学将其归属于“腹痛”范畴,认为本病病因除腹部中寒、胃肠热结、脾胃虚寒外,还包括乳食积滞和瘀血内阻等,病位主要在脾、胃、大肠,病机关键为脾胃肠腑气滞,不通则痛,临床多以内治法结合中医特色外治法辨证论治,标本兼治,在缓解症状、降低复发率、缩短病程、减少不良反应等方面较西药有不可替代的优势。通过中医学论之,对肠系膜淋巴结炎的病因病机做出阐述,对内治法、内外合治法,尤其是临床常用的中医外治法灸法、穴位贴敷疗法、推拿疗法进行了系统的总结和梳理,以其有效率为基准,总结出可用于指导临床的中医特色诊疗方案。