Gross C R, Lindquist R D, Woolley A C, Granieri R, Allard K, Webster B
College of Pharmacy, University of Minnesota, Minneapolis 55455.
J Emerg Med. 1992 May-Jun;10(3):267-74. doi: 10.1016/0736-4679(92)90331-m.
To determine which of the signs and symptoms of dehydration obtainable from patient history and physical examination in the emergency department are most useful in assessing the severity of dehydration in elderly patients.
Prospective, correlational study.
Two university teaching hospitals.
Fifty-five patients aged 60 or older presenting to the emergency department with suspected dehydration were studied.
In the emergency department, patients were evaluated by a standardized history and physical examination that included assessment of 38 signs and symptoms commonly attributed to dehydration. The relationships between the presence and intensity of these putative dehydration indicators and an independent rating of dehydration severity based on a comprehensive review of the medical record were evaluated. Also evaluated were the relationships between these dehydration indicators and patient age. Indicators that correlated best with dehydration severity but were unrelated to patient age included: tongue dryness (P less than 0.001), longitudinal tongue furrows (P less than 0.001), dryness of the mucous membranes of the mouth (P less than 0.001), upper body muscle weakness (P less than 0.001), confusion (P less than 0.001), speech difficulty (P less than 0.01), and sunkenness of eyes (P less than 0.01). Other indicators had only weak associations with dehydration severity or were also related to age. Patient thirst was unrelated to dehydration severity.
A set of signs and symptoms related to dehydration severity in elderly patients has been identified. These indicators may be more useful for evaluation of dehydration severity in the emergency department than other commonly used indicators.
确定在急诊科通过患者病史和体格检查可获得的哪些脱水体征和症状最有助于评估老年患者的脱水严重程度。
前瞻性相关性研究。
两家大学教学医院。
对55名60岁及以上因疑似脱水就诊于急诊科的患者进行了研究。
在急诊科，通过标准化的病史和体格检查对患者进行评估，其中包括对38种通常归因于脱水的体征和症状的评估。评估了这些假定的脱水指标的存在和强度与基于全面病历审查的脱水严重程度独立评级之间的关系。还评估了这些脱水指标与患者年龄之间的关系。与脱水严重程度相关性最佳但与患者年龄无关的指标包括：舌干（P<0.001）、舌纵沟（P<0.001）、口腔黏膜干燥（P<0.001）、上身肌肉无力（P<0.001）、意识模糊（P<0.001）、言语困难（P<0.01）和眼窝凹陷（P<0.01）。其他指标与脱水严重程度的关联较弱或也与年龄有关。患者口渴与脱水严重程度无关。
已确定一组与老年患者脱水严重程度相关的体征和症状。这些指标在急诊科评估脱水严重程度方面可能比其他常用指标更有用。
