Hickey Christina A, Beattie T James, Cowieson Jennifer, Miyashita Yosuke, Strife C Frederic, Frem Juliana C, Peterson Johann M, Butani Lavjay, Jones Deborah P, Havens Peter L, Patel Hiren P, Wong Craig S, Andreoli Sharon P, Rothbaum Robert J, Beck Anne M, Tarr Phillip I
Division of Gastroenterology and Nutrition, Department of Pediatrics, Washington University School of Medicine, 1 Children's Place, St Louis, MO 63110, USA.
Arch Pediatr Adolesc Med. 2011 Oct;165(10):884-9. doi: 10.1001/archpediatrics.2011.152. Epub 2011 Jul 22.
To determine if interventions during the pre-hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS.
Prospective observational cohort study.
Eleven pediatric hospitals in the United States and Scotland.
Children younger than 18 years with diarrhea-associated HUS (hematocrit level <30% with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count <150 × 10³/mm³), and impaired renal function (serum creatinine concentration > upper limit of reference range for age).
Intravenous fluid was given within the first 4 days of the onset of diarrhea.
Presence or absence of oligoanuria (urine output ≤ 0.5 mL/kg/h for >1 day).
The overall oligoanuric rate of the 50 participants was 68%, but was 84% among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95% confidence interval, 1.1-2.4; P = .02). Children with oligoanuric HUS were given less total intravenous fluid (r = -0.32; P = .02) and sodium (r = -0.27; P = .05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried.
Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.
确定在溶血尿毒综合征（HUS）腹泻期进行干预是否与HUS期间尿量维持有关。
前瞻性观察队列研究。
美国和苏格兰的11家儿科医院。
18岁以下患有腹泻相关性HUS（血细胞比容水平<30%且血涂片有血管内红细胞破坏证据）、血小板减少（血小板计数<150×10³/mm³）和肾功能受损（血清肌酐浓度>年龄参考范围上限）的儿童。
在腹泻发作的前4天内给予静脉输液。
少尿或无少尿（尿量≤0.5 mL/kg/h超过1天）的情况。
50名参与者的总体少尿率为68%，但在疾病发作的前4天未接受静脉输液的参与者中，少尿率为84%。在此期间未给予输液时少尿的相对风险为1.6（95%置信区间，1.1 - 2.4；P = 0.02）。与无少尿的儿童相比，少尿性HUS儿童在疾病发作的前4天接受的总静脉输液量（r = -0.32；P = 0.02）和钠量（r = -0.27；P = 0.05）更少。在多变量分析中，最显著的协变量是输注量，但量和钠密切相关。
静脉补液扩容是一种未得到充分利用的干预措施，可降低有HUS风险患者少尿性肾衰竭的发生率。
