原作者： Hong Kim，江利冰 译 肖锋 校 文章来源： 《中华急诊医学杂志》编辑部 发布日期：2014-07-09
Title: Predictors of esophageal injury in caustic ingestion?
题目：预测吞食腐蚀性物质导致食管损伤的指标？
Author 作者: Hong Kim
江利冰 译 肖锋 校
Caustic ingestion can potentially cause significant esophageal and/or gastric injury that can lead to significant morbidity, including death.
吞食腐蚀性物质可以引起严重的食管损伤和/或胃脏损伤，从而导致严重的并发症包括死亡。
Endoscopy is often performed:
通常要做内镜：
· To determine the presence of caustic injury.
判断是否存在腐蚀性损伤。
· To determine the severity of caustic injury (grade: I to III).
判断腐蚀性损伤的严重程度（等级：I 至 III）
· Placement of orogastric or nasograstic tube for nutritional support if needed (grade IIb and III)
如果需要，可经口或经鼻置放胃管进行营养支持（等级IIb 和 III）
Evidence for predictor of esophageal injury (frequently cited) comes from mostly studies involving pediatric population and unintentional ingestion:
食管损伤预测因子的证据（经常被引用）主要来自涉及儿科人群以及误服腐蚀剂的研究：
1. 文献： Gaudreault et al. Pediatrics 1983;71:767-770.
Studied signs/symptoms: nausea, vomiting, dysphagia, refusal to drink, abdominal pain, drooling or oropharyngeal burn
体征/症状：恶心，呕吐，吞咽困难，拒绝饮水，腹部疼痛，流涎或者口咽部烧灼感。
Presence of symptoms: Grade 0/I lesion: 82%; Grade II: 18%
有临床症状：0/I级损伤：82%；II级损伤：18%
Absence of symptoms: Grade 0/I: 88%; Grade II: 12%
没有临床症状：0/I级损伤：88%；II级损伤：12%
2. 文献 Crain et al. Am J Dis Child. 1984;138(9):863-865
Presence of 2 or more (vomiting, drooling and stridor) identified all (n=7) grade II and III lesion.
存在2种或2种以上症状（呕吐，流涎和喘鸣）可以识别所有的II 级和 III 级损伤（n=7）。
Presence of 1 or no symptoms: no grade II/III lesions
存在一种或者不存在任何症状：没有II 级和 III 级损伤。
Stridor alone associated with grade II/III lesions (n=2)
单独出现喘鸣和II 级和 III 级损伤有关（n=2）。
10% of patients without oropharyngeal burns had grade II/III lesions.
10%的患者没有口咽部的烧灼感可以出现II 级和 III 级损伤。
3. 文献： Gorman et al. Am J Emerge Med 1990;10(3):189-194.
Two or more symptoms: vomiting, dysphagia, abdominal pain or oral burns
两种或者两种以上临床症状：呕吐，吞咽困难，腹部疼痛或者口腔内烧灼感。
Sensitivity: 94%; specificity 49%
敏感度：94%；特异度：49%。
Positive predictive value 43% ; negative predictive value: 96%
阳性预测值：43%；阴性预测值96%。
Stridor alone (n=3): grade II or greater lesion
只有喘鸣（n=3）：II 或者II 级以上损伤。
4. 文献： Previtera et al. Pediatric Emerg Care 1990;6(3):176-178.
Esopheal injury in 37.5% of patients without oropharyngeal burn
37.5%的食管损伤的患者没有口咽部的烧灼感。
Grade II/III injury: 8 patients
II/III 级损伤：8例患者
Available data suggests that there are no “good” or reliable predictors for esophageal injury.
目前已有的数据提示还没有很好的或者可靠的指标预测食管损伤。
However, high suspicion for gastrointestinal injury should be considered with GI consultation for endoscopy in the presence of
但是，如果内镜检查确诊为I 级损伤，同时存在以下情况时应高度怀疑胃肠道的损伤：
· Stridor alone
只有喘鸣
· Two or more sx: vomiting, drooling or stridor (Crain et al)
两种或者两种以上临床症状：呕吐，流涎或者喘鸣 (作者：Crain et al)
· Intentional suicide attempt
故意企图自杀
