Rocha Crisanta, Silva Sheyla, Gordon Aubree, Hammond Samantha N, Elizondo Douglas, Balmaseda Angel, Harris Eva
Unidad de Infectología, Hospital Infantil Manuel del Jesús Rivera, Managua, Nicaragua.
Am J Trop Med Hyg. 2009 Aug;81(2):287-92.
Dengue is a major problem worldwide, and improving case management is a significant priority. In consultation with colleagues in Thailand, changes in management of hospitalized dengue cases were introduced in Nicaragua, including oral rather than intravenous (IV) fluids upon admission, continuous monitoring of clinical and laboratory signs, and use of IV fluids principally during the critical phase and colloids in management of shock. Two periods were compared, before (2003) and after (2005) their implementation, to assess impact. In 2003, 182 hospitalized laboratory-confirmed dengue cases 0-14 years of age who presented < or = 5 days post-symptom onset were included in the study; 46 were enrolled in 2005. Outcomes included significant reductions in days of IV fluid administration ( P = 0.0001), number of patients receiving IV fluids ( P < 0.0001), and duration of hospitalization ( P < 0.0001), and a non-significant reduction in the number of admissions to the intensive care unit from 8 in 2003 to 0 in 2005 ( P = 0.36). This study demonstrates concrete gains in dengue patient care and case management.
登革热是一个全球性的重大问题，改善病例管理是一项重要的优先事项。在与泰国同事协商后，尼加拉瓜引入了住院登革热病例管理的变化，包括入院时使用口服而非静脉（IV）补液、持续监测临床和实验室指标，以及在关键阶段主要使用静脉补液和在休克管理中使用胶体液。比较了实施这些措施之前（2003年）和之后（2005年）两个时期，以评估影响。2003年，182例0至14岁、症状出现后≤5天住院的实验室确诊登革热病例纳入研究；2005年纳入46例。结果包括静脉补液天数显著减少（P = 0.0001）、接受静脉补液的患者数量减少（P < 0.0001）、住院时间缩短（P < 0.0001），以及重症监护病房入院人数从2003年的8例非显著减少至2005年的0例（P = 0.36）。这项研究表明在登革热患者护理和病例管理方面取得了切实成效。
