Method for painless air enema operation of crying type infantile intussusception

Abstract

The application relates to the technical field of pediatric emergency treatment, and particularly discloses a painless air enema operation method for a crying type pediatric intussusception. The method comprises the following steps: S1, performing general anesthesia on a child diagnosed as the crying type intussusception, then inserting an enema catheter into the colon of the child through the anus of the child, and connecting the tail end of the catheter with an air source; S2, forming a pressure pulse in the colon through the catheter; S3, touching the intussusception mass on the abdomen of the child with the hand of an operator, and synchronously adjusting the body position of the child; S4, intussusception reduction determination: characteristic changes of the pressure pulse form, disappearance of the abdominal mass, air over water sound or active borborygmus heard in the right lower abdomen; S5, maintaining the colon filling with continuous and flat air lower than the peak pressure of the pressure pulse, then discharging the gas in the intestine, and completing the reduction. The enema operation method can be used for emergency reduction treatment of the crying type pediatric intussusception in medical institutions, and has the advantages of eliminating pain and ionizing radiation, and reducing the risks of intestinal perforation and re-intussusception.

Description

Technical Field

[0001] This application relates to the field of pediatric emergency treatment technology, and more specifically, it relates to a method for painless air enema in crying children with intussusception. Background Technology

[0002] Intussusception in children is one of the most common acute abdominal conditions in infancy, with a high incidence in infants aged 4-10 months. Currently, the mainstream non-surgical reduction techniques in clinical practice are air enema under X-ray fluoroscopy and hydrostatic enema under ultrasound guidance. Among them, air enema under X-ray fluoroscopy is a widely used and mature method. Its advantages lie in its mature operation procedure, high equipment availability, and fast reduction speed, with an overall reduction success rate of 70%-90%, allowing most children to avoid the trauma of open surgery. As a radiation-free alternative, hydrostatic enema under ultrasound guidance relies on real-time ultrasound imaging to monitor the displacement of the intussusception mass, thus avoiding ionizing radiation. It has been gradually promoted in pediatric hospitals, and for children within 24 hours of onset and in good general condition, the reduction effect is basically equivalent to that of the X-ray guidance method. At the same time, traditional air enema equipment is simple and has low consumable costs, making it suitable for rapid implementation in emergency departments of primary healthcare institutions.

[0003] The entire process of air enema under X-ray fluoroscopy involves exposure to ionizing radiation. Infants and young children are in a critical stage of growth and development, and their tissues and organs are more sensitive to radiation than adults. Although the radiation dose of a single enema is low, there is still a potential risk of long-term tumor development. Moreover, medical staff also face occupational radiation hazards from long-term operation. At the same time, traditional methods are often performed when the child is awake and crying. Violent crying not only causes drastic fluctuations in intra-abdominal pressure and generates abdominal muscle contractions that resist repositioning, significantly prolonging the operation time, but also causes severe pain stimulation and psychological trauma to the child. Furthermore, the agitation caused by crying can interfere with the operator's palpation judgment of abdominal masses, forcing the operator to blindly increase the enema pressure. In addition, the traditional continuous constant pressure enema mode subjectes the intestinal wall to static high pressure for a long time, which can easily cause ischemia and hypoxia of the intestinal mucosa and stress accumulation in the serosal layer. After repositioning, intestinal wall edema and elastic recoil are not effectively relieved, making it impossible to simultaneously achieve the treatment goals of painless, radiation-free, and low risk of complications. Summary of the Invention

[0004] To address the issues of painless, radiation-free, and low-complication risks associated with air enemas under X-ray fluoroscopy, this application provides a method for painless air enema in children with crying intussusception.

[0005] This application provides a method for painless air enema in children with crying intussusception, using the following technical solution: The procedure for painless air enema in infants with crying intussusception includes the following steps: S1. Administer general anesthesia to the child diagnosed with crying-type intussusception, and then insert the enema catheter into the colon through the child's anus, with the end of the catheter connected to an air source; S2. Air is intermittently injected into and released into the colon through the catheter to form a series of pressure pulses. The waveform of the pressure pulses simulates the rhythmic rise and fall of intra-abdominal pressure when an infant cries. Each pulse includes a pressure-boosting phase and a pressure-relaxing phase. S3. During the application of the pressure pulse, the operator palpates the child's abdomen with their hand to sense the changes in the hardness and displacement of the mass during the impact and relaxation phases, and adjusts the pressure increase rate or peak pressure duration of subsequent pressure pulses in real time based on the palpation feedback; simultaneously adjust the child's position so that the child is in a head-down, hip-up position during the impact phase of each pulse, and in a horizontal or head-up position during the relaxation phase, thus forming a phased coordination between the position and the pressure pulse. S4. When the intussusception is successfully reduced by at least two of the following indicators: characteristic changes in the pressure pulse pattern, dissipation of the abdominal mass, and the sound of gurgling or active bowel sounds heard in the right lower quadrant, the pulse application shall be terminated. S5. Maintain colon distension with continuous advection air at a pressure lower than the peak pressure of the pressure pulse, then expel the gas from the intestines, and the repositioning is complete.

[0006] By employing the above-mentioned technical solution, pulsed airflow simulating the rhythm of an infant's crying abdominal pressure is applied into the colon under general anesthesia, and simultaneously combined with palpation feedback adjustment and postural synergy, the intussuscepted intestinal segment withstands axial retraction during the impact phase and regains blood supply during the relaxation phase, thus avoiding cumulative damage to the intestinal wall caused by continuous high pressure. Palpation and multimodal assessment completely replace fluoroscopy, and the entire reduction process does not require the child's crying or resistance, nor does it require pressing or fixing. Therefore, while eliminating pain and ionizing radiation, the reduction of crying-type intussusception is achieved with a lower average airway pressure, and the risk of intestinal perforation and re-intussusception is reduced.

[0007] Preferably, step S1 also includes confirming, through ultrasound examination, that the child has a concentric circle sign in the right lower abdomen or right upper abdomen and that the ileocecal junction and appendix are not clearly visible, thereby diagnosing the crying type of intussusception.

[0008] By adopting the above technical solution, the specific sonographic images of the concentric circle sign of the ileocecal region and the unclear visualization of the appendix can be clearly identified by ultrasound before anesthesia. This allows for the accurate screening of the type of intussusception targeted by this method, excluding other acute abdominal conditions with clear ileocecal anatomy. This ensures that the subsequent pulse reduction operation is directly applied to the spastic and tightly contracted intussusception of the large intestine, thereby improving the targeting of the reduction strategy.

[0009] Preferably, in step S2, the pressure pulse has a short duration of pressure rise and rapid pressure increase, and the pressure drop relaxation period quickly brings the pressure back to a baseline close to zero, with the pulse cycle interval simulating the crying rhythm of an infant.

[0010] By adopting the above technical solution, the rapid rising branch of the pressure pulse reproduces the instantaneous thrust generated by the violent contraction of the abdominal muscles during crying, while the rapid pressure drop simulates the state of abdominal wall relaxation during the interval between crying. This rhythmic mechanical stimulation repeatedly induces the stress relaxation of the intussusception ring and stimulates local intestinal peristalsis. At the same time, it allows the intestinal mucosa to obtain blood reperfusion during each relaxation period, thereby continuously accumulating axial retraction displacement without avoiding intestinal wall ischemia, and reducing the total pressure load required for repositioning.

[0011] Preferably, in step S2, the peak pressure of the pressure pulse is controlled within the peak range of intra-abdominal pressure when the infant cries, and is lower than the maximum pressure allowed by conventional continuous enemas.

[0012] By adopting the above technical solution, since the pulse pressure only reaches its peak for a short time, the total amount of gas and wall stress acting on the intestinal wall are much smaller than those of continuous enema at the same pressure level. Therefore, the intussusception head is driven to retract with a power amplitude close to the physiological abdominal pressure, without causing stress concentration or serosa tearing near the spasm ring. This improves the success rate of reduction while keeping the risk of perforation and pneumoperitoneum at a low level.

[0013] Preferably, in step S2, the pressure pulse is achieved by manually squeezing the airbag connected to the conduit.

[0014] By adopting the above technical solution, the operator can directly control the amplitude and waveform of the pressure pulse by squeezing and releasing the airbag with their hands. The pressure sensation of the fingers will intuitively feed back the changes in resistance during the release of the intussusception to the operator. This allows the strength and speed of each pulse to be adjusted in a timely manner according to the changes in the patency of the intestinal lumen. There is no need to rely on additional electrical or mechanical pressure regulating devices. This simplifies the equipment conditions and realizes precise pressure control operation with human-machine coordination, making it easy to implement in various medical settings.

[0015] Preferably, in step S3, the real-time adjustment of the palpation feedback is as follows: when the palpation senses that the mass is spasmodic and hard, the pressure rise rate of the subsequent pulse is appropriately increased or the duration of the peak pressure is appropriately prolonged; when the sensed mass begins to show rhythmic axial movement, the current pulse characteristics are maintained; when the sensed mass dissipates rapidly, the pulse application is immediately terminated.

[0016] By adopting the above technical solution, since the operator's palpation fingers are placed directly on the projection of the intussusception mass, information on three levels—spasm hardness, loosening degree, and axial slippage—can be distinguished in real time. Based on this, the pulse parameters can be corrected in a timely manner, so that the pulse energy is concentrated to overcome the spasm resistance. Once the intussusception begins to move, it switches to a maintenance and propulsion state. After the reduction is completed, the impact is stopped immediately, thus avoiding the repeated traction of the reduced bowel segment by ineffective pulses. This makes the entire operation process a closed-loop adaptive control centered on touch, shortening the effective reduction time.

[0017] Preferably, in step S3, the synchronous adjustment of the child's position is as follows: the child is tilted with head down and hips up before each impact period, and immediately returns to a horizontal position after the impact period ends.

[0018] By adopting the above technical solution, the timing of the body position change and the pressure pulse is precisely locked. The axial component of gravity and the air pressure thrust that are instantaneously superimposed during the impact period act together on the intussusception head, enhancing the retraction driving force of a single pulse. Meanwhile, the relaxation period and the return to a horizontal body position remove the additional gravitational load, ensuring that the intestinal wall obtains undisturbed venous return and arterial reperfusion when the pressure is released. This phase coordination improves the effectiveness of the pulse without increasing airway pressure, allowing the repositioning to be completed under gentler air pressure conditions.

[0019] Preferably, in step S3, the palpation hand is also used to sense the axial displacement amplitude of the mass under pulse impact.

[0020] By adopting the above technical solution, the operator's fingertips can not only perceive the change in the hardness of the mass, but also capture the slight sliding distance of the intussusception head along the direction of colon at the moment of impact. The presence and amplitude of axial displacement directly reflect the actual effect of pulse propulsion, thus providing another dimension of real-time basis for adjusting the intensity and direction of subsequent pulses in addition to the change in hardness, and enhancing the ability to judge irreversible intussusception.

[0021] Preferably, in step S4, the characteristic change in the pressure pulse pattern refers to the occurrence of a small, sudden fluctuation during the pressure rise in the impact period, followed by the pulse baseline becoming flat and stable.

[0022] By adopting the above technical solution, the intestinal lumen suddenly becomes open at the moment the intussusception head retracts, and the airflow resistance drops sharply, causing the pressure curve to exhibit a characteristic momentary tremor when it rises. Subsequently, the baseline becomes flat and neat due to the unobstructed state of the entire colon. This change in mechanical characteristics is directly captured by the pressure gauge, forming an endogenous indication signal that identifies successful repositioning without any imaging equipment. This signal is corroborated by information from abdominal palpation and auscultation, improving the objectivity and accuracy of repositioning judgment under zero-radiation conditions.

[0023] Preferably, in step S5, the pressure at which the colon is maintained by a continuous advection of air below the peak pressure is much lower than the peak pressure of the pulse impact period, and the maintenance time is sufficient to allow the intestinal tract to expand.

[0024] By adopting the above technical solution, the gentle advection air pressure is immediately replaced with the impact pulse after repositioning, so that the newly repositioned ileocecal junction and ascending colon remain in an expanded state under appropriate support, avoiding early re-intussusception induced by elastic recoil of the intestinal wall or local edema. At the same time, the stable low-pressure environment is conducive to the recovery of intestinal mucosal microcirculation, reducing the delayed recovery of intestinal function after repositioning, thereby consolidating the immediate effect of pulse repositioning without increasing additional risks.

[0025] In summary, this application has the following beneficial effects: 1. Because this application uses pulsed air enema under general anesthesia to simulate the rhythm of abdominal pressure during infant crying, and replaces continuous and stable high pressure with rhythmic mechanical stimulation that alternates between pressure-raising and pressure-depressing relaxation phases, the intussuscepted intestinal segment obtains regular intermittent blood supply restoration while bearing axial retraction force, eliminating the cumulative stress damage to the intestinal wall caused by continuous high pressure. Thus, it is possible to achieve low-perforation risk reduction of crying-type intussusception without relying on radiation fluoroscopy, and to avoid the pain and crying of the child and relieve the anxiety of the parents.

[0026] 2. This application preferably adopts a real-time adjustment mechanism that links palpation sensation with pulse parameters, as well as a coordinated operation mode that locks the body position change with the pressure pulse phase. Since the palpation fingers directly sense the spasm hardness, looseness and axial slippage of the intussusception mass and immediately correct the pulse strength and speed, the axial component of gravity and the air pressure thrust are enhanced in the same direction during the impact period when the head is low and the buttocks are high. The additional load is completely removed when the body position is restored to a horizontal position during the relaxation period. This improves the propulsion efficiency of each pulse at a lower airway pressure level, thereby shortening the operation time required for intussusception reduction without increasing the burden of intestinal wall traction.

[0027] 3. The method of this application makes a comprehensive judgment based on three indicators: sudden fluctuations in the pressure pulse pattern and changes in baseline flattening, rhythmic movement and dissipation of abdominal intestinal patterns, and active gurgling sounds or bowel sounds in the right lower abdomen. Since the mechanical signal generated by the instantaneous retraction of the intussusception head through the intestinal lumen is directly captured by the pressure gauge, and the information from palpation and auscultation corroborates it, the determination of successful repositioning does not require any imaging equipment and is objective and immediate. Thus, it truly realizes closed-loop operation under zero radiation conditions and broadens the applicable scenarios of this operation method.

[0028] 4. The method of this application maintains colonic distension for a moment with continuous advection air at a level far below the peak impact after successful reduction, and then expels air. Since the newly reduced ileocecal junction and ascending colon remain in a relaxed state under gentle support, the elastic retraction tendency of the intestinal wall is counteracted and the impact of local edema on the lumen is alleviated. At the same time, the low-pressure environment creates conditions for the recovery of intestinal mucosal microcirculation, thereby consolidating the immediate effect of pulse reduction and reducing the occurrence of early re-intussusception. Combined with the accurate identification of the concentric circle sign and unclear appendix visualization by preoperative B-ultrasound, the entire operation forms a coherent closed loop in the three stages of indication screening, reduction implementation and effect consolidation, improving the overall reliability of painless air enema operation for crying intussusception. Attached Figure Description

[0029] Figure 1 This is a flowchart of the procedure for painless air enema in children with crying intussusception as proposed in this application; Figure 2 This figure shows a comparison of the repositioning success rate and intestinal wall perforation rate between the embodiments and comparative examples proposed in this application. Figure 3 This is a comparison diagram of the accuracy of reset determination under non-transparent conditions between the embodiments and comparative examples proposed in this application; Figure 4 This is a graph showing the comparison between the average operation time and the early re-overlapping rate of the embodiments and comparative examples proposed in this application. Detailed Implementation

[0030] The present application will be further described in detail below with reference to the accompanying drawings and embodiments.

[0031] Technical concept: This application discloses a painless air enema procedure for pediatric intussusception with crying symptoms. The procedure includes the following steps: S1, administering general anesthesia to the child diagnosed with crying intussusception, then inserting the enema catheter into the colon through the child's anus, with the catheter's tail end connected to an air source; S2, generating a pressure pulse into the colon through the catheter; S3, during the application of the pressure pulse, the operator palpates the intussusception mass in the child's abdomen with their hand, simultaneously adjusting the child's position; S4, determining intussusception reduction: characteristic changes in the pressure pulse morphology, dissipation of the abdominal mass, and the audible gurgling sound or active bowel sounds in the right lower quadrant; S5, maintaining colonic distension with a continuous advection of air at a pressure lower than the peak pressure of the pressure pulse, then expelling the intestinal gas, completing the reduction.

[0032] This application employs a pulsed air enema under general anesthesia, simulating the rhythm of abdominal pressure during infant crying. This rhythmic mechanical stimulation, alternating between a pressure-boosting phase and a pressure-reducing relaxation phase, replaces continuous, stable high pressure. As a result, the intussuscepted intestinal segment, while bearing the axial retraction force, achieves regular intermittent blood supply restoration, eliminating the cumulative stress damage to the intestinal wall caused by continuous high pressure. This allows for low-risk reduction of crying-type intussusception without relying on fluoroscopy, while also avoiding pain and crying in the child and alleviating the anxiety of the parents.

[0033] Example 1: This example provides a method for painless air enema in children with crying intussusception, including the following steps: S1. Administer general anesthesia to the child diagnosed with crying-type intussusception, and then insert the enema catheter into the colon through the child's anus, with the end of the catheter connected to an air source; The S1 step also includes confirming the presence of concentric circles in the right lower or right upper abdomen of the child through ultrasound examination, and making the ileocecal junction and appendix unclear, thus diagnosing the crying type of intussusception.

[0034] S2. Air is intermittently injected into and released into the colon through a catheter, forming a series of pressure pulses. The waveform of the pressure pulses simulates the rhythmic rise and fall of intra-abdominal pressure when an infant cries. Each pulse includes a pressure-boosting phase and a pressure-relaxing phase. In step S2, the pressure pulse's boosting phase lasts for 0.3 seconds, and the pressure relief phase reduces the pressure to a baseline of 5 mmHg within 1 second. The pulse cycle is 3 seconds.

[0035] In step S2, the peak pressure of the pressure pulse is 40 mmHg.

[0036] In step S2, the pressure pulse is achieved by manually squeezing the airbag connected to the catheter.

[0037] S3. During the application of the pressure pulse, the operator palpates the child's abdomen with their hands to sense the changes in the hardness and displacement of the mass during the impact and relaxation phases, and adjusts the pressure increase rate or peak pressure duration of subsequent pressure pulses in real time based on the palpation feedback; simultaneously adjust the child's position so that the child is in a head-down, hip-up position during the impact phase of each pulse, and in a horizontal or head-up position during the relaxation phase, thus forming a phased coordination between the position and the pressure pulse. In step S3, the real-time adjustment of palpation feedback is as follows: when the palpation senses a spasmodic and hard mass, the boost rate of subsequent pulses is increased or the peak duration is extended; when the sensed mass begins to move rhythmically, the current pulse parameters are maintained; when the sensed mass dissipates rapidly, the pulse application is immediately terminated.

[0038] In step S3, the patient's position is adjusted synchronously as follows: the tilt angle of the head-down, hip-up position is 10°, and the position is changed to head-down, hip-up position just before the start of each impact period, and immediately returned to horizontal position after the impact period ends.

[0039] In step S3, the palpation hand is also used to sense the axial displacement amplitude of the mass under pulse impact.

[0040] S4. When the intussusception is successfully reduced by at least two of the following indicators: characteristic changes in the pressure pulse pattern, dissipation of the abdominal mass, and the sound of gurgling or active bowel sounds heard in the right lower quadrant, the pulse application shall be terminated. In step S4, the characteristic change in the pressure pulse pattern refers to the occurrence of small, sudden fluctuations during the pressure rise in the impact period, followed by a flattening of the baseline.

[0041] S5. Maintain colon distension with a continuous advection of air at a pressure lower than the peak pressure of the pressure pulse, then expel the gas from the intestines, and the repositioning is complete.

[0042] In step S5, the colon is kept full at a pressure of 10 mmHg with a continuous advection of air below the peak pressure for 1 minute.

[0043] Example 2: This example provides a method for painless air enema in children with crying intussusception, including the following steps: S1. Administer general anesthesia to the child diagnosed with crying-type intussusception, and then insert the enema catheter into the colon through the child's anus, with the end of the catheter connected to an air source; The S1 step also includes confirming the presence of concentric circles in the right lower or right upper abdomen of the child through ultrasound examination, and making the ileocecal junction and appendix unclear, thus diagnosing the crying type of intussusception.

[0044] S2. Air is intermittently injected into and released into the colon through a catheter, forming a series of pressure pulses. The waveform of the pressure pulses simulates the rhythmic rise and fall of intra-abdominal pressure when an infant cries. Each pulse includes a pressure-boosting phase and a pressure-relaxing phase. In step S2, the pressure pulse's boosting phase lasts for 0.55 seconds, and the pressure relief phase reduces the pressure to a baseline of 7.5 mmHg within 1 second. The pulse cycle is 4 seconds.

[0045] In step S2, the peak pressure of the pressure pulse is 60 mmHg.

[0046] In step S2, the pressure pulse is achieved by manually squeezing the airbag connected to the catheter.

[0047] S3. During the application of the pressure pulse, the operator palpates the child's abdomen with their hands to sense the changes in the hardness and displacement of the mass during the impact and relaxation phases, and adjusts the pressure increase rate or peak pressure duration of subsequent pressure pulses in real time based on the palpation feedback; simultaneously adjust the child's position so that the child is in a head-down, hip-up position during the impact phase of each pulse, and in a horizontal or head-up position during the relaxation phase, thus forming a phased coordination between the position and the pressure pulse. In step S3, the real-time adjustment of palpation feedback is as follows: when the palpation senses a spasmodic and hard mass, the boost rate of subsequent pulses is increased or the peak duration is extended; when the sensed mass begins to move rhythmically, the current pulse parameters are maintained; when the sensed mass dissipates rapidly, the pulse application is immediately terminated.

[0048] In step S3, the patient's position is adjusted synchronously as follows: the tilt angle of the head-down, hip-up position is 12.5°, and the position is changed to head-down, hip-up position just before the start of each impact period, and immediately returned to horizontal position after the impact period ends.

[0049] In step S3, the palpation hand is also used to sense the axial displacement amplitude of the mass under pulse impact.

[0050] S4. When the intussusception is successfully reduced by at least two of the following indicators: characteristic changes in the pressure pulse pattern, dissipation of the abdominal mass, and the sound of gurgling or active bowel sounds heard in the right lower quadrant, the pulse application shall be terminated. In step S4, the characteristic change in the pressure pulse pattern refers to the occurrence of small, sudden fluctuations during the pressure rise in the impact period, followed by a flattening of the baseline.

[0051] S5. Maintain colon distension with a continuous advection of air at a pressure lower than the peak pressure of the pressure pulse, then expel the gas from the intestines, and the repositioning is complete.

[0052] In step S5, the colon is kept full at a pressure of 12.5 mmHg with a continuous advection of air below the peak pressure for 2 minutes.

[0053] Example 3: This example provides a method for painless air enema in children with crying intussusception, including the following steps: S1. Administer general anesthesia to the child diagnosed with crying-type intussusception, and then insert the enema catheter into the colon through the child's anus, with the end of the catheter connected to an air source; The S1 step also includes confirming the presence of concentric circles in the right lower or right upper abdomen of the child through ultrasound examination, and making the ileocecal junction and appendix unclear, thus diagnosing the crying type of intussusception.

[0054] S2. Air is intermittently injected into and released into the colon through a catheter, forming a series of pressure pulses. The waveform of the pressure pulses simulates the rhythmic rise and fall of intra-abdominal pressure when an infant cries. Each pulse includes a pressure-boosting phase and a pressure-relaxing phase. In step S2, the pressure pulse's boosting impact period lasts for 0.8 seconds, and the pressure reduction relaxation period reduces the pressure to a baseline of 10 mmHg within 1 second. The pulse cycle is 5 seconds.

[0055] In step S2, the peak pressure of the pressure pulse is 80 mmHg.

[0056] In step S2, the pressure pulse is achieved by manually squeezing the airbag connected to the catheter.

[0057] S3. During the application of the pressure pulse, the operator palpates the child's abdomen with their hands to sense the changes in the hardness and displacement of the mass during the impact and relaxation phases, and adjusts the pressure increase rate or peak pressure duration of subsequent pressure pulses in real time based on the palpation feedback; simultaneously adjust the child's position so that the child is in a head-down, hip-up position during the impact phase of each pulse, and in a horizontal or head-up position during the relaxation phase, thus forming a phased coordination between the position and the pressure pulse. In step S3, the real-time adjustment of palpation feedback is as follows: when the palpation senses a spasmodic and hard mass, the boost rate of subsequent pulses is increased or the peak duration is extended; when the sensed mass begins to move rhythmically, the current pulse parameters are maintained; when the sensed mass dissipates rapidly, the pulse application is immediately terminated.

[0058] In step S3, the patient's position is adjusted synchronously as follows: the tilt angle of the head-down, hip-up position is 15°, and the position is changed to head-down, hip-up position just before the start of each impact period, and immediately returned to the horizontal position after the impact period ends.

[0059] In step S3, the palpation hand is also used to sense the axial displacement amplitude of the mass under pulse impact.

[0060] S4. When the intussusception is successfully reduced by at least two of the following indicators: characteristic changes in the pressure pulse pattern, dissipation of the abdominal mass, and the sound of gurgling or active bowel sounds heard in the right lower quadrant, the pulse application shall be terminated. In step S4, the characteristic change in the pressure pulse pattern refers to the occurrence of small, sudden fluctuations during the pressure rise in the impact period, followed by a flattening of the baseline.

[0061] S5. Maintain colon distension with a continuous advection of air at a pressure lower than the peak pressure of the pressure pulse, then expel the gas from the intestines, and the repositioning is complete.

[0062] In step S5, the colon is kept full at a pressure of 15 mmHg with a continuous advection of air below the peak pressure for 3 minutes.

[0063] Comparative Example 1: This comparative example refers to the content of Example 1, except that in step S2, no pulsed pressure waveform is applied. Instead, air is continuously injected into the colon through a catheter and a constant pressure of 40 mmHg is maintained. The operator only observes the pressure gauge and changes in the abdominal intestinal pattern. The enema is stopped when the pressure gauge pointer suddenly drops or the abdominal mass dissipates. The rest of the content is the same as in Example 1.

[0064] Comparative Example 2: This comparative example refers to the content of Example 1, except that the duration of the pressure pulse boosting impact period in step S2 is extended to 2 seconds, the pressure is reduced to the baseline of 5 mmHg within 2 seconds during the depressurization relaxation period, and the pulse period is extended to 7 seconds. The rest of the content is the same as that of Example 1.

[0065] Comparative Example 3: This comparative example refers to the content of Example 1, except that in step S3, the operator does not palpate the abdominal mass with their hands, and does not perform the operation of real-time adjustment of pulse parameters based on palpation feedback. The pulse parameters remain unchanged throughout the process after being set in S2. The rest of the content is the same as in Example 1.

[0066] Comparative Example 4: This comparative example refers to the content of Example 1, except that the body position is not adjusted synchronously in step S3, and the body is kept in a horizontal supine position throughout the process. The rest of the content is the same as that of Example 1.

[0067] Comparative Example 5: This comparative example refers to the content of Example 1, except that in step S4, only the characteristic change in the pressure pulse pattern is used to determine successful repositioning. The dissipation of the abdominal mass and the auscultation results of the right lower abdomen are not used as the basis for repositioning. The rest of the content is the same as that of Example 1.

[0068] Comparative Example 6: This comparative example refers to the content of Example 1, except that in step S5, the colon is not kept full by continuous advection of air, and the gas in the intestine is directly discharged after the pulse application is terminated. The low-pressure advection consolidation operation is not performed. The rest of the content is the same as Example 1.

[0069] Performance testing Sample preparation: Healthy New Zealand white rabbits weighing between 1.5 and 2.5 kg were selected as test subjects. All animals were acclimatized under standard environmental conditions for one week. Before the experiment, they were fasted for twelve hours but had free access to water. Subsequently, they were anesthetized by a combined intramuscular injection of ketamine and diazepam. After the anesthesia took effect, the rabbits were fixed in a supine position. The ileocecal region was exposed through a small incision in the midline of the abdomen. A specially made fine probe was used to push the terminal ileum into the cecum and the beginning of the ascending colon to create an intussusception model with a controllable length. After successful modeling, the abdomen was closed layer by layer and the animals were allowed to recover. The successful modeled animals were randomly assigned to each example and comparative group using a random number table method. The sample size of each group was no less than ten. Enema operation was started within thirty minutes after the modeling was completed.

[0070] Success rate of repositioning and perforation rate detection: Animals in each group were placed in a supine position and connected to electrocardiogram and respiratory monitoring equipment. Air enema was performed according to the corresponding group's operation procedure. X-ray fluoroscopy or digital subtraction angiography equipment was not used throughout the process. The judgment was based solely on pressure sensor readings, changes in palpable masses, and changes in bowel sounds. The highest pressure value reached by each animal during the operation and whether there were signs of suspected perforation such as rapid breathing, abdominal muscle tension, and sudden increase in abdominal distension were recorded. If perforation was suspected, the operation was stopped immediately and an autopsy was performed for verification. The final judgment criteria for successful repositioning and no perforation were natural repositioning of the intestine and the presence of continuous and intact intestinal wall without tearing or bleeding during autopsy. The success rate of repositioning and the perforation rate of each group were statistically analyzed. The criteria for perforation were visible rupture of the serosal layer or obvious signs of pneumoperitoneum accompanied by deterioration of vital signs. The upper limit of pressure was set with reference to the intestinal tolerance threshold of small mammals and an automatic pressure relief protection was set. All count results were summarized according to the experimental animal surgical operation safety evaluation standards. The management and ethical review of animal experiments for this testing project comply with GB / T35823-2018 "General Requirements for Laboratory Animal Experiments", and the anatomical judgment criteria are implemented in accordance with the relevant technical specifications for laboratory animal surgery.

[0071] Accuracy testing of intussusception reduction determination under fluoroscopic conditions: For each animal that underwent the group-specific procedure and was declared to have successfully reduced intussusception, a second observer, unaware of the grouping, reassessed the animal within five minutes of the procedure using abdominal palpation and auscultation. Immediately following, a direct anatomical examination or exploratory laparotomy was performed. Complete reduction of the intestinal tract under direct vision without significant serosa damage was used as the gold standard. The accuracy, misjudgment rate, and missed judgment rate for each group were statistically analyzed when determination was based solely on three clinical indicators: palpation feedback, changes in pressure waveform, and active bowel sounds. A misjudgment was defined as a declared reduction but anatomical examination confirming the presence of intussusception; a missed judgment was defined as anatomical examination confirming reduction but not simultaneously meeting two or more clinical indicators. The determination procedure followed the standard methods for evaluating the effectiveness of intussusception reduction during laboratory animal surgery. Anatomical verification was jointly confirmed and recorded by two observers. The diagnostic accuracy verification for this test was conducted in accordance with the recommendations for transparency and blinded evaluation in the ARRIVE 2.0 Animal Experiment Reporting Guidelines. The anatomical determination criteria complied with the relevant provisions of GB / T35823-2018 "General Requirements for Laboratory Animal Experiments".

[0072] Early re-intussusception rate detection after reduction: All animal models with successful enema reduction and intact intestinal segments confirmed by dissection were not subjected to additional intervention before abdominal closure. Postoperatively, they continued routine feeding and were observed for 24 hours, recording any recurrence of intestinal obstruction symptoms such as vomiting after feeding, abdominal distension, and lethargy. At the end of the observation period, a second dissection was performed, and the early re-intussusception rate was statistically analyzed for each group. Re-intussusception was defined as intussusception of the intestinal segment accompanied by local congestion and edema. The difference in re-intussusception rate between the example group and the six control groups was particularly compared to verify the effectiveness of low-pressure advection air maintenance. The intestinal filling step plays a role in consolidating the reduction effect. The observation window and recurrence statistics are based on the reporting standards for the 24-hour recurrence rate in small animal intussusception model studies. The time and severity of all re-intussusception events are recorded. The postoperative observation period, animal welfare and humane endpoint settings of this test strictly follow the relevant provisions of GB / T35823-2018 "General Requirements for Laboratory Animal Experiments" and GB / T42011-2022 "General Rules for Laboratory Animal Welfare". The recurrence judgment criteria are implemented in accordance with the relevant technical specifications of laboratory animal surgery.

[0073] Table 1: Comparison of Repositioning Success Rate and Intestinal Wall Perforation Rate Example 1 94.7 0.0 Example 2 96.2 0.0 Example 3 97.8 1.1 Comparative Example 1 62.3 18.9 Comparative Example 2 71.4 11.5 Comparative Example 3 78.6 7.1 Comparative Example 4 82.1 3.6 Comparative Example 5 89.3 1.8 Comparative Example 6 92.9 0.0

[0074] Table 2: Comparison of Repositioning Judgment Accuracy under Non-fluoroscopic Conditions Example 1 97.8 1.1 1.1 Example 2 98.9 0.0 1.1 Example 3 98.9 1.1 0.0 Comparative Example 1 68.4 21.1 10.5 Comparative Example 2 75.0 17.9 7.1 Comparative Example 3 82.1 10.7 7.1 Comparative Example 4 85.7 8.9 5.4 Comparative Example 5 73.2 23.2 3.6 Comparative Example 6 96.4 2.2 1.4 Table 3: Comparison of average operation time and early re-collapse rate Example 1 4.2 2.3 Example 2 3.7 1.1 Example 3 3.1 1.1 Comparative Example 1 11.8 12.7 Comparative Example 2 9.5 9.8 Comparative Example 3 7.9 6.3 Comparative Example 4 6.8 4.5 Comparative Example 5 4.8 3.6 Comparative Example 6 3.9 17.9 Example Conclusion: As can be seen from Examples 1-3 and Comparative Example 1, and Table 1, using a pulsed pressure waveform that simulates the rhythm of an infant's crying abdominal pressure to replace a continuous and stable high pressure can effectively eliminate cumulative stress damage to the intestinal wall, reduce the risk of perforation, and improve the success rate of repositioning. This demonstrates the synergistic promoting effect of rhythmic mechanical stimulation on the restoration of intestinal blood supply and axial retraction.

[0075] Based on Examples 1-3 and Comparative Example 2, and in conjunction with Table 1, it can be seen that optimizing the ratio of the duration of the pressure pulse's boosting and depressurizing phases can ensure propulsion efficiency while avoiding excessive traction on the intestinal wall. This verifies that a suitable pulse cycle is a regulatory factor that balances repositioning speed and operational safety.

[0076] As can be seen from Examples 1-3 and Comparative Example 3, and in conjunction with Tables 1 and 2, the introduction of a real-time linkage adjustment mechanism between palpation sensation and pulse parameters enables the operation to dynamically respond to changes in the hardness and displacement of the intussusception mass, significantly enhancing the precise control and accuracy of the repositioning process and avoiding the risks associated with blindly applying pressure.

[0077] Combining Examples 1-3 and Comparative Example 4 with Tables 1 and 2, it can be seen that by implementing the coordinated operation of body position change and pressure pulse phase locking, and utilizing the gravity-assisted effect of the head-low-hips-high position during the impact period, the axial propulsion efficiency can be improved without increasing the air pressure load, demonstrating the synergistic effect of multiple physical fields on the reset effect.

[0078] As can be seen from Examples 1-3 and Comparative Example 5, and Table 2, by comprehensively applying the three indicators of pressure waveform change, abdominal mass dissipation, and active bowel sounds for repositioning judgment, a closed-loop verification logic under radiation-free conditions was constructed, which greatly improved the reliability and objectivity of operational decisions and avoided the risk of misjudgment caused by a single indicator.

[0079] As can be seen from Examples 1-3 and Comparative Example 6, and Table 3, maintaining colonic distension with continuous advection air pressure below the peak pressure after repositioning can counteract the elastic retraction tendency of the intestinal wall and alleviate local edema, consolidate the immediate repositioning effect, and reduce the incidence of early re-intussusception, demonstrating the impact of postoperative consolidation steps on long-term stability.

[0080] This specific embodiment is merely an explanation of this application and is not intended to limit it. After reading this specification, those skilled in the art can make modifications to this embodiment without contributing any inventive step, but such modifications are protected by patent law as long as they fall within the scope of the claims of this application.

Claims

1. A method for painless air enema in infants with crying-type intussusception, characterized in that, Includes the following steps: S1. Administer general anesthesia to the child diagnosed with crying-type intussusception, and then insert the enema catheter into the colon through the child's anus, with the end of the catheter connected to an air source; S2. Air is intermittently injected into and released into the colon through the catheter to form a series of pressure pulses. The waveform of the pressure pulses simulates the rhythmic rise and fall of intra-abdominal pressure when an infant cries. Each pulse includes a pressure-boosting phase and a pressure-relaxing phase. S3. During the application of the pressure pulse, the operator palpates the child's abdomen with their hand to sense the changes in the hardness and displacement of the mass during the impact and relaxation phases, and adjusts the pressure increase rate or the duration of the peak pressure of the subsequent pressure pulses in real time based on the palpation feedback. Synchronously adjust the child's position so that the child is in a head-down, hip-up position during the impact phase of each pulse, and in a horizontal or head-up position during the relaxation phase, thus forming a phased coordination between the position and the pressure pulse. S4. When the intussusception is successfully reduced by at least two of the following indicators: characteristic changes in the pressure pulse pattern, dissipation of the abdominal mass, and the sound of gurgling or active bowel sounds heard in the right lower quadrant, the pulse application shall be terminated. S5. Maintain colon distension with continuous advection air at a pressure lower than the peak pressure of the pressure pulse, then expel the gas from the intestines, and the repositioning is complete.

2. The method for painless air enema in children with crying intussusception according to claim 1, characterized in that, Step S1 also includes confirming the presence of concentric circles in the right lower or right upper quadrant of the child through ultrasound examination, and making the ileocecal junction and appendix unclear, thus diagnosing the crying type of intussusception.

3. The method for painless air enema in children with crying intussusception according to claim 1, characterized in that, In step S2, the duration of the pressure pulse's boosting impact period is 0.3 to 0.8 seconds, the pressure reduction relaxation period reduces the pressure to a baseline of 5 to 10 mmHg within 1 second, and the pulse period is 3 to 5 seconds.

4. The method for painless air enema in crying infants with intussusception according to claim 1, characterized in that, In step S2, the peak pressure of the pressure pulse is 40–80 mmHg.

5. The method for painless air enema in crying infants with intussusception according to claim 1, characterized in that, In step S2, the pressure pulse is achieved by manually squeezing the airbag connected to the catheter.

6. The method for painless air enema for crying-type intussusception in children according to claim 1, characterized in that, In step S3, the real-time adjustment of the palpation feedback is as follows: when the palpation senses that the mass is spasmodic and hard, the boost rate of the subsequent pulse is increased or the peak duration is extended. When the sensed packet begins to move rhythmically, maintain the current pulse parameters; The pulse application is terminated immediately when the sensed mass rapidly dissipates.

7. The method for painless air enema in crying infants with intussusception according to claim 1, characterized in that, In step S3, the synchronized adjustment of the child's position is as follows: the tilt angle of the head-down, hip-up position is 10° to 15°, and the head-down, hip-up position is changed instantaneously before the start of each impact period, and the position is immediately restored to horizontal after the end of the impact period.

8. The method for painless air enema for crying-type intussusception in children according to claim 1, characterized in that, In step S3, the palpation hand is also used to sense the axial displacement of the mass under pulse impact.

9. The method for painless air enema for crying infantile intussusception according to claim 1, characterized in that, In step S4, the characteristic change in the pressure pulse pattern refers to the occurrence of a small, sudden fluctuation during the pressure rise in the impact period, followed by the baseline becoming flat.

10. The method for painless air enema for crying-type intussusception in children according to claim 1, characterized in that, In step S5, the pressure at which the colon is maintained by a continuous advection of air below the peak pressure is 10-15 mmHg, and the maintenance time is 1-3 minutes.

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