Freedman Stephen B, Adler Mark, Seshadri Roopa, Powell Elizabeth C
Division of Pediatric Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
N Engl J Med. 2006 Apr 20;354(16):1698-705. doi: 10.1056/NEJMoa055119.
Vomiting limits the success of oral rehydration in children with gastroenteritis. We conducted a double-blind trial to determine whether a single oral dose of ondansetron, an antiemetic, would improve outcomes in children with gastroenteritis.
We enrolled 215 children 6 months through 10 years of age who were treated in a pediatric emergency department for gastroenteritis and dehydration. After being randomly assigned to treatment with orally disintegrating ondansetron tablets or placebo, the children received oral-rehydration therapy according to a standardized protocol. The primary outcome was the proportion who vomited while receiving oral rehydration. The secondary outcomes were the number of episodes of vomiting and the proportions who were treated with intravenous rehydration or hospitalized.
As compared with children who received placebo, children who received ondansetron were less likely to vomit (14 percent vs. 35 percent; relative risk, 0.40; 95 percent confidence interval, 0.26 to 0.61), vomited less often (mean number of episodes per child, 0.18 vs. 0.65; P<0.001), had greater oral intake (239 ml vs. 196 ml, P=0.001), and were less likely to be treated by intravenous rehydration (14 percent vs. 31 percent; relative risk, 0.46; 95 percent confidence interval, 0.26 to 0.79). Although the mean length of stay in the emergency department was reduced by 12 percent in the ondansetron group, as compared with the placebo group (P=0.02), the rates of hospitalization (4 percent and 5 percent, respectively; P=1.00) and of return visits to the emergency department (19 percent and 22 percent, P=0.73) did not differ significantly between groups.
In children with gastroenteritis and dehydration, a single dose of oral ondansetron reduces vomiting and facilitates oral rehydration and may thus be well suited for use in the emergency department.
呕吐会影响小儿肠胃炎口服补液的治疗效果。我们进行了一项双盲试验，以确定单剂量口服昂丹司琼（一种止吐药）是否能改善小儿肠胃炎的治疗效果。
我们招募了215名6个月至10岁因肠胃炎和脱水在儿科急诊科接受治疗的儿童。在随机分配接受口腔崩解型昂丹司琼片或安慰剂治疗后，这些儿童按照标准化方案接受口服补液治疗。主要结局是接受口服补液时呕吐的儿童比例。次要结局是呕吐发作次数以及接受静脉补液或住院治疗的儿童比例。
与接受安慰剂的儿童相比，接受昂丹司琼的儿童呕吐的可能性较小（14% 对35%；相对风险，0.40；95% 置信区间，0.26至0.61），呕吐频率较低（每名儿童的平均发作次数，0.18对0.65；P<0.001），口服摄入量更多（239毫升对196毫升，P=0.001），接受静脉补液治疗的可能性较小（14% 对31%；相对风险，0.46；95% 置信区间，0.26至0.79）。尽管与安慰剂组相比，昂丹司琼组在急诊科的平均住院时间缩短了12%（P=0.02），但两组之间的住院率（分别为4%和5%；P=1.00）和返回急诊科就诊率（19%和22%，P=0.73）没有显著差异。
对于患有肠胃炎和脱水的儿童，单剂量口服昂丹司琼可减少呕吐并促进口服补液，因此可能非常适合在急诊科使用。
