| ObjectiveWith acidic and alkaline compounds are widely used in daily life, the probability for people to touch with corrosive substances is higher and higher and swallowing acid and alkali corrosive substances becoming more and more common because of various reasons at the same time. After oral corrosive substance poisoning, there may have more severe gastrointestinal injury, such as gastrointestinal bleeding, perforation, esophageal tracheal fistula, etc., and even death, it may cause digestive tract stenosis, lead to malnutrition, gastrointestinal disorders, directly affect the quality of life of patients in the later. Early assessment of the digestive tract damage degree and early treatment can improve the prognosis of patients obviously.Now mostly adopting the classification standard of severity of the upper gastrointestinal injury based on endoscopic appearances, providing an important reference for the evaluation of the digestive tract damage degree that Grade0 means mucosa is normal; GradeⅠmeans mucosal hyperemia, swelling; GradeⅡa-class, means it is visible to see scattered in the superficial ulcer, erosion, seepage(liquid); Based on Grade Ⅱ a-class, GradeⅡb-class appears isolated, circular deep ulcer; Grade Ⅲa-class shows multiple deep ulcers, partly appeared necrotic mucosa; Grade Ⅲ b-class extensively shows mucosal necrosis; Grade Ⅳis perforation. In early endoscopic damage evaluation, given different treatment according to the esophagus, stomach and damage degree, patients in a lesser injury degree can discharged from the hospital after symptomatic treatment, and the patients in relatively heavy injury degree need dynamic observation condition, suitable parenteral nutrition, acid suppression, antibiotics, to maintain electrolyte balance, rehydration support therapy, for patients with serious injury degree are need early gastrointestinal resection treatment.Therefore, we observed upper gastrointestinal mucosa damage through endoscopic observation after oral corrosive substance, classified standard of the digestive tract injuries according to Zargar, carries on correlation analysis of injury classification and digestive tract stricture factor after injury with general condition and laboratory examination of patients, exploring factors associated with damage degree, the stricture to provide clinical basis for early intervention treatment, providing research foundation by reducing the late incidence of upper gastrointestinal tract stricture and improving the life quality of patients prognosis at the same time. ContentRetrospective analysis to selected 150 cases of upper gastrointestinal tract injury patients caused by oral corrosive substances, including patient general condition, admission time, clinic time after admission to hospital, whether on an empty stomach when intake corrosive, nature of the corrosive substance, clinical feature(symptoms and signs), the main test results(blood routine, allergic C reactive protein, liver function, renal function, myocardial enzyme, the sternum), etc. Initial endoscopy was taken in 4 to 5 days after corrosive ingestion, according to the Zargar standard classified initial upper gastrointestinal tract injury from Grade0 to Grade IV, and proceed to observe endoscopic mucosal restoration and digestive tract stricture in the fourth week, eighth week after the corrosive ingestion. MethodGrade the upper gastrointestinal tract injury according to the criteria of Zargar injury classification. At the same time, the late digestive tract stenosis should be divided into stenosis group and no narrow.Adopting Spearman rank correlation analysis improve the digestive tract damage statistical analysis, which the age, clinical time, white blood cell count. Using 2cinspection to whether the gender, retrosternal pain, whether there is any difficulty swallowing, fasting conditions, presence of gastrointestinal bleeding, corrosive degree of the strength of the material properties. After the relevant factors are obtained, using multiple logistic regression analysis. At the same time, adopting to do single factor logistic regression analysis with digestive tract stenosis, then using multiple logistic regression analysis. All statistical analysis adopted SPSS 20.0 statistical software, when P< 0.05 it has statistical significance. ResultAmong the 150 cases, 87 were male, 63 were female, age 10 to 83 years old and average age was(43.45 ± 15.46) years old. 121 cases were suicide, 29 cases were accidental; 130 cases were married, 20 cases were unmarried; 59 cases were housewives, 38 cases were farmers, 16 cases were students, 18 cases were workers, 19 cases were unemployed.10 cases(6.67%) of the patients were fasting oral corrosive substance, 140 cases(93.34%) were intake after taking 7 food. 61 cases were ingested strong oral corrosive substances,89 cases were ingested oral acid-base corrosive substances. The main clinical manifestations were: 139 cases sore throat(92.67%), 76 cases chest pain(50.67%), 102 cases abdominal pain(68.0%), 80 cases gastrointestinal bleeding(53.33%). Some patients have nausea, salivation, breathing difficult, chest pain, dysphagia, esophageal perforation, 1 case is mediastinitis(0.67%), and 1 case is mediastinal emphysema(0.67%). White blood cell count of mean±standard deviation(12.05±5.94)×109/L.Results showed that among 150 cases of patients with initial endoscopic check, all gastrointestinal injury of 150 patients were within III b-class, the level of esophageal Grade 0 accounted for 18.0%, GradeⅠaccounted for 18.0%, Grade II a-class accounted for 43.33%, Grade II b-class accounted for 11.33%, Grade III a-class accounted for 7.33%, Grade III class b accounted for 2.0%; The level of gastric Grade0 accounted for 0.0%, Grade I accounted for16.0%, Grade II class-a accounted for 17.3%, Grade II b-class accounted for 41.33%, Grade III a-class accounted for 20%, Grade III b-class accounted for 5.33%; All of the patients were not treated with emergency surgery, and there were no perforation symptoms in the thoracic and abdominal CT examination, and no obvious injury of the duodenal mucosa was found in the patients within GradeⅢ.Among the follow-up diagnosed patients after corrosive poisoning 4 weeks and 8 weeks, 8 patients were lost to follow-up, 142 patients referral, of which 20 cases were esophageal stenosis, 20 cases were pyloric stenosis.For patients with grade0, grade I and II a-class in initial endoscopic digestive tract injury, digestive tract mucosa repaired integrity, digestive tract stenosis rate was 0, the prognosis was good when they reviewed of endoscopy after poisoning 4 weeks and 8 weeks. In patients with gastric injury grade II b-class, the rate of gastric injury was 0, In patients with esophageal injury grade II b-class and the rate of stenosis was 41.8%; Gastric injury grading of for patients with grade III a-class, incidence of pyloric stenosis rate was 40.0%, for esophageal injury grade III a-class patients, esophageal stenosis rate was 90.91%, for both stomach and esophageal injury with grade III b-class patients, the stenosis rate was 100%.Grade the upper gastrointestinal tract injury according to the criteria of Zargar injury classification, namely grade 0, I, II a, II b, III as, III b-class. Filtrating the factors of age, sex, retrosternal pain, dysphagia, fasting, gastrointestinal bleeding, oral corrosion material properties and intensity, white blood cell count, clinic time, using the spearman rank and inspection, count data using 2c test, do single factor logistic regression analysis. Filtrate P<0.1, respectively reach correlation with injury factor conclusion that fasting, oral corrosion material properties and intensity, white blood cell count.at the same time, the correlation with stenosis factor that white blood cell count, clinic time. All these factor using multiple logistic regression analysis, reach a conclusion that factors of white blood cell count is the risk influence factor of the digestive tract severity and stricture, the clinic time is the risk influence factor of the digestive tract stricture. ConclusionThis study is domestic oral corrosive substance first reported case of upper gastrointestinal tract after injury. This study suggests that factors of white blood cell count is the risk influence factor of the digestive tract severity and stricture, the clinic time is the risk influence factor of the digestive tract stricture. |
PDF Full Text Request