Hartling L, Bellemare S, Wiebe N, Russell K, Klassen T P, Craig W
Cochrane Database Syst Rev. 2006 Jul 19;2006(3):CD004390. doi: 10.1002/14651858.CD004390.pub2.
Dehydration associated with gastroenteritis is a serious complication. Oral rehydration is an effective and inexpensive treatment, but some physicians prefer intravenous methods.
To compare oral with intravenous therapy for treating dehydration due to acute gastroenteritis in children.
We searched the Cochrane Infectious Diseases Group Specialized Register (March 2006), CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to March 2006), EMBASE (1974 to March 2006), LILACS (1982 to March 2006), and reference lists. We also contacted researchers, pharmaceutical companies, and relevant organizations.
Randomized and quasi-randomized controlled trials comparing intravenous rehydration therapy (IVT) with oral rehydration therapy (ORT) in children up to 18 years of age with acute gastroenteritis.
Two authors independently extracted data and assessed quality using the Jadad score. We expressed dichotomous data as a risk difference (RD) and number needed to treat (NNT), and continuous data as a weighted mean difference (WMD). We used meta-regression for subgroup analyses.
Seventeen trials (1811 participants), of poor to moderate quality, were included. There were more treatment failures with ORT (RD 4%, 95% confidence interval (CI) 1 to 7, random-effects model; 1811 participants, 18 trials; NNT = 25). Six deaths occurred in the IVT group and two in the ORT groups (4 trials). There were no significant differences in weight gain (369 participants, 6 trials), hyponatremia (248 participants, 2 trials) or hypernatremia (1062 participants, 10 trials), duration of diarrhea (960 participants, 8 trials), or total fluid intake at six hours (985 participants, 8 trials) and 24 hours (835 participants, 7 trials). Shorter hospital stays were reported for the ORT group (WMD -1.20 days, 95% CI -2.38 to -0.02 days; 526 participants, 6 trials). Phlebitis occurred more often in the IVT group (NNT 50, 95% CI 25 to 100) and paralytic ileus more often in the ORT group (NNT 33, 95% CI 20 to 100, fixed-effect model), but there was no significant difference between ORT using the low osmolarity solutions recommended by the World Health Organization and IVT (729 participants, 6 trials).
AUTHORS' CONCLUSIONS: Although no clinically important differences between ORT and IVT, the ORT group did have a higher risk of paralytic ileus, and the IVT group was exposed to risks of intravenous therapy. For every 25 children (95% CI 14 to 100) treated with ORT one would fail and require IVT.
与肠胃炎相关的脱水是一种严重的并发症。口服补液是一种有效且廉价的治疗方法，但一些医生更倾向于静脉治疗方法。
比较口服疗法与静脉疗法治疗儿童急性肠胃炎所致脱水的效果。
我们检索了Cochrane传染病组专业注册库（2006年3月）、Cochrane系统评价数据库（《Cochrane图书馆》2006年第1期）、医学索引数据库（1966年至2006年3月）、荷兰医学文摘数据库（1974年至2006年3月）、拉丁美洲及加勒比地区卫生科学数据库（1982年至2006年3月）以及参考文献列表。我们还联系了研究人员、制药公司及相关组织。
比较静脉补液疗法（IVT）与口服补液疗法（ORT）治疗18岁及以下患有急性肠胃炎儿童的随机和半随机对照试验。
两位作者独立提取数据，并使用Jadad评分评估质量。我们将二分数据表示为风险差（RD）和需治疗人数（NNT），将连续数据表示为加权均数差（WMD）。我们使用Meta回归进行亚组分析。
纳入了17项质量从差到中等的试验（1811名参与者）。ORT组的治疗失败情况更多（RD 4%，95%置信区间（CI）1至7，随机效应模型；1811名参与者，18项试验；NNT = 25）。IVT组有6例死亡，ORT组有2例死亡（4项试验）。在体重增加（369名参与者，6项试验）、低钠血症（248名参与者，2项试验）或高钠血症（1062名参与者，10项试验）、腹泻持续时间（960名参与者，8项试验）、6小时（985名参与者，8项试验）和24小时（835名参与者，7项试验）的总液体摄入量方面没有显著差异。ORT组报告的住院时间较短（WMD -1.20天，95% CI -2.38至-0.02天；526名参与者，6项试验）。IVT组静脉炎的发生更频繁（NNT 50，95% CI 25至100），ORT组麻痹性肠梗阻的发生更频繁（NNT 33，95% CI 20至100，固定效应模型），但使用世界卫生组织推荐的低渗溶液的ORT与IVT之间没有显著差异（729名参与者，6项试验）。
尽管ORT和IVT之间没有临床上的重要差异，但ORT组麻痹性肠梗阻的风险更高，IVT组存在静脉治疗的风险。每25名接受ORT治疗的儿童（95% CI 14至100）中就有1名会治疗失败并需要IVT。
