부식제 음독 환자에서 초기 내시경 소견의 중증도에 따른 임상 소견 및 예후 비교
Comparison of Clinical Characteristics and Prognosis by Initial Endoscopic Severity in Caustic Injury
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: We investigated comparison of clinical characteristics and prognosis by initial endoscopic severity in caustic injury and then discussed predisposing factors which can be helpful in predicting the prognosis and determining the treatment. Methods: This study was a retrospective review of medical records from patients over the age of 15, who underwent initial endoscopy for caustic injury from April 2007 through November 2014. Patients were classified according to two groups based on the initial endoscopic finding by Zargar’s classification: patients with grade 0, I, IIa at esophagus (low risk group) and patients with grade IIb, IIIa, IIIb at esophagus (high risk group). The two groups were then compared. Results: A total of 55 patients were included (low risk group [n=44] vs. high risk group [n=11]). Old age (p<0.001), large amount of ingestion (p<0.05), oropharyngeal symptoms (p<0.01), high SOFA score (p<0.001), high WBC count (p<0.05), low base excess (p<0.01), and HCO3 (p<0.05) were statistically significant factors in the high risk group. A poor prognosis was observed for hospital stay (p<0.001), ICU admission (p<0.001), mortality (p<0.01), and stricture (p<0.001) in the high risk group. Conclusion: Clinical characteristics including age, amount of ingestion, oropharyngeal symptoms, SOFA score, WBC count, base excess, and HCO3 can be helpful in the decision to undergo initial endoscopy and risk assessment by initial endoscopic severity can be helpful in predicting prognosis and determining the treatment plan.
Abstract
Purpose: We investigated comparison of clinical characteristics and prognosis by initial endoscopic severity in caustic injury and then discussed predisposing factors which can be helpful in predicting the prognosis and determining the treatment. Methods: This study was a retrospective review of medical records from patients over the age of 15, who underwent initial endoscopy for caustic injury from April 2007 through November 2014. Patients were classified according to two groups based on the initial endoscopic finding by Zargar’s classification: patients with grade 0, I, IIa at esophagus (low risk group) and patients with grade IIb, IIIa, IIIb at esophagus (high risk group). The two groups were then compared. Results: A total of 55 patients were included (low risk group [n=44] vs. high risk group [n=11]). Old age (p<0.001), large amount of ingestion (p<0.05), oropharyngeal symptoms (p<0.01), high SOFA score (p<0.001), high WBC count (p<0.05), low base excess (p<0.01), and HCO3 (p<0.05) were statistically significant factors in the high risk group. A poor prognosis was observed for hospital stay (p<0.001), ICU admission (p<0.001), mortality (p<0.01), and stricture (p<0.001) in the high risk group. Conclusion: Clinical characteristics including age, amount of ingestion, oropharyngeal symptoms, SOFA score, WBC count, base excess, and HCO3 can be helpful in the decision to undergo initial endoscopy and risk assessment by initial endoscopic severity can be helpful in predicting prognosis and determining the treatment plan.
참고문헌 (21)
- Yoon KW, "A clinical study on the upper gastrointestinal tract injury caused by corrosive agent", Korean J Gastrointest Endosc, 23, pp.82~87 (2001)
- 염혜정, "부식제로 인한 상부 위장관 손상의 임상양상 및 예후인자", 대한내과학회지, 70(4), pp.371~377 (2006), 대한내과학회
- Goldman LP, "Corrosive substance ingestion : a review", Am J Gastroenterol, 79, pp.85~90 (1984)
- Cox AJ, "Ingestion of caustic hair relaxer: is endoscopy necessary?", Laryngoscope, 107, pp.897~902 (1997)
- Kay M, "Caustic ingestions and the role of endoscopy", J Pediatr Gastroenterol Nutr, 32, pp.8~10 (2001)
- Poley JW, "Ingestion of acid and alkaline agents : outcome and prognostic value of early upper endoscopy", Gastrointest Endosc, 60, pp.372~377 (2004)
- Temiz A, "Longterm management of corrosive esophageal stricture with balloon dilation in children", Surg Endosc, 24, pp.2287~2292 (2010)
- Zargar SA, "Ingestion of corrosive acids. Spectrum of injury to upper gastrointestinal tract and natural history", Gastroenterology, 97, pp.702~707 (1989)
- Zargar SA, "The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns", Gastrointest Endosc, 37, pp.165~169 (1991)
- Zargar SA, "Ingestion of strong corrosive alkalis : spectrum of injury to upper gastrointestinal tract and natural history", Am J Gastroenterol, 87, pp.337~341 (1992)
- Ertekin C, "The results of caustic ingestions", Hepatogastroenterology, 51, pp.1397~1400 (2004)
- Cheng HT, "Caustic ingestion in adults : the role of endoscopic classification in predicting outcome", BMC Gastroenterol, 8, pp.31~ (2008)
- Previtera C, "Predictive value of visible lesions (cheeks, lips, oropharynx) in suspected caustic ingestion: may endoscopy reasonably be omitted in completely negative pediatric patients?", Pediatr Emerg Care, 6, pp.176~178 (1990)
- Rigo GP, "What is the utility of selected clinical and endoscopic parameters in predicting the risk of death after caustic ingestion?", Endoscopy, 34, pp.304~310 (2002)
- Cheng YJ, "Arterial blood gas analysis in acute caustic ingestion injuries", Surg Today, 33, pp.483~485 (2003)
- Choe MSP, "Application of poisoning aBIG score for prediction of fatal severity in acute adult intoxications", J Korean Soc Clin Toxicol, 12, pp.14~21 (2014)
- Zygun D, "SOFA is superior to MOD score for the determination of non-neurologic organ dysfunction in patients with severe traumatic brain injury: a cohort study", Crit Care, 10, pp.R115~ (2006)
- Vincent JL, "Use of the SOFA score to assess the incidence of organ dysfunction", failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine, 1998, pp.26, 1793~1800
- 최지은, "동맥혈 가스분석을 이용한 부식제 음독 환자의 전신 합병증 발생의 위험도 예측", 대한응급의학회지, 23(6), pp.811~818 (2012), 대한응급의학회
- Kim YS, "The clinical characteristics and risk factors of upper digestive lesions that are due to ingestion of caustic material", J Korean Soc Clin Toxicol, 7, pp.113~120 (2009)
- 송혜경, "부식제로 인한 상부위장관 손상: 단일 3차 기관의 20년간의 후향적 분석", 대한소화기학회지, 65(1), pp.12~20 (2015), 대한소화기학회