da Cunha Ferreira R M, Cash R A
Department of Pediatrics, Hospital de Santa Maria, University of Lisbon, Portugal.
Clin Ther. 1990;12 Suppl A:2-11; discussion 11-3.
Humans have often used oral fluids to replace perceived losses of water, either instinctively or with a therapeutic orientation in the form of folk remedies. Replacement therapy with intravenous (IV) fluids was formally introduced in the last century for the treatment of patients with cholera. The modern implementation of oral replacement therapy was begun by pediatricians in the 1940s who used electrolyte solutions as maintenance therapy in mildly purging children with diarrhea. However, the scientific development of oral rehydration therapy (ORT) has occurred only in the last 30 years. Basic physiologic research in the 1950s demonstrated the cotransport mechanism of sodium and organic solutes (sugars and amino acids) in the intestinal cells, thereby establishing the scientific basis for ORT. The use of ORT based on scientific observations was first reported in 1964 from the Philippines by Phillips and coworkers. Research laboratories in Dhaka and Calcutta subsequently demonstrated that the mechanism of sodium and glucose cotransport remains intact in cholera patients and that oral solutions can successfully rehydrate and maintain hydration in these patients. Clinical studies carried out in Dhaka and Calcutta confirmed the efficacy of oral rehydration solutions (ORS) and showed that nearly 80% of IV fluid could be saved if patients were hydrated by the oral route. Further studies demonstrated the safety and efficacy of ORT in patients of all ages suffering from acute diarrhea of any cause. The use of ORT has substantially reduced morbidity and mortality from acute diarrhea, particularly after the World Health Organization adopted and promoted ORT on a worldwide scale. Researchers continue to search for better ORS formulations in terms of safety, efficacy, availability, and cost. Food-based ORS are a promising area of research. The use of a sound scientific method, the establishment of a close link between basic and clinical science, and the use of field studies have proved to be major assets in the development of ORT.
人类常常通过口服液体来补充所感觉到的水分流失，这可能是出于本能，也可能是以民间疗法的形式带有治疗目的。静脉输液替代疗法于上世纪正式引入，用于治疗霍乱患者。现代口服替代疗法始于20世纪40年代的儿科医生，他们使用电解质溶液作为维持疗法，用于轻度腹泻的儿童。然而，口服补液疗法（ORT）的科学发展仅在过去30年才出现。20世纪50年代的基础生理学研究证明了肠道细胞中钠和有机溶质（糖和氨基酸）的协同转运机制，从而奠定了ORT的科学基础。1964年，菲利普斯及其同事首次从菲律宾报道了基于科学观察的ORT的使用情况。达卡和加尔各答的研究实验室随后证明，霍乱患者体内钠和葡萄糖的协同转运机制仍然完好，口服溶液能够成功地为这些患者补充水分并维持水合状态。在达卡和加尔各答进行的临床研究证实了口服补液溶液（ORS）的疗效，并表明如果通过口服途径为患者补水，几乎可以节省80%的静脉输液。进一步的研究证明了ORT对所有年龄段、任何病因引起的急性腹泻患者的安全性和有效性。ORT的使用大幅降低了急性腹泻的发病率和死亡率，尤其是在世界卫生组织在全球范围内采用并推广ORT之后。研究人员继续在安全性､有效性､可及性和成本方面寻找更好的ORS配方。基于食物的ORS是一个有前景的研究领域。使用可靠的科学方法、建立基础科学与临床科学之间的紧密联系以及开展实地研究已被证明是ORT发展的主要优势。
