Pignatelli Salvatore, Musumeci Salvatore
Saint Camille Medical Center, Ouagadougou, Burkina Faso.
Departments of Pharmacology, Gynecology and Obstetrics, and Pediatrics, University of Sassari, Sassari, Italy ; Institute of Population Genetics, National Research Council, Alghero, Italy.
Curr Ther Res Clin Exp. 2003 Mar;64(3):189-202. doi: 10.1016/S0011-393X(03)00021-3.
The administration of hydrating solutions and early refeeding improve recovery for infants and children with diarrhea.
The aim of this study was to assess the efficacy of a low-osmolarity (30 mEq/L Na(+)) solution administered after the standard, high-osmolarity (90 mEq/L Na(+)) solution via a nasogastric tube (NGT) and followed by early refeeding to achieve more rapid body weight recovery in infants and children with acute diarrhea.
Infants and children aged <5 years with acute diarrhea and dehydration (body weight loss of ≥10%) observed from January to August 2001 at Saint Camille Medical Center, Ouagadougou, Burkina Faso, were enrolled. Patients were randomized to 1 of 3 treatment protocols. Patients in group A received, via NGT, rehydration with a high-osmolarity solution for 3 hours, followed by a low-osmolarity solution for at least 3 additional hours. Patients in group B were given only a low-osmolarity solution via NGT. In group C, rehydration was carried out using a high-osmolarity solution via NGT.
Four thousand consecutively treated infants and children (2010 boys, 1990 girls; mean [SD] age, 3.5 [2.7] years) were enrolled. After the first 6 hours of infusion, 90% of the patients who had received the combined rehydration (group A) showed significant body weight recovery, versus 80% and 79% of the patients in groups B and C, respectively. Stool output significantly decreased for group A compared with groups B and C (114 vs 125 and 120 g/kg, respectively). Only 7% of the patients in group A required prolonged rehydration (>6 hours) with the low-osmolarity solution, versus 10% and 12% in groups B and C, respectively. A total of 3% of patients treated with combined rehydration required hospitalization, compared with 10% and 9% in groups B and C, respectively. At the end of infusion, 25% of the patients rehydrated only with a low-osmolarity solution showed poor body weight recovery and appeared lethargic, versus 10% in group A and 15% in group C. Patients who were rehydrated with a high-osmolarity solution showed symptoms of hypernatremia (serum Na(+) concentration >140 mEq/L). At the end of rehydration (≥6 hours), all patients recovered their previous body weight, partially or totally, and refeeding was begun. Rehydration and diet were continued at home, or in neighboring areas for those living far away.
In this study population, the administration of a high-osmolarity solution followed by a low-osmolarity solution and early refeeding was effective in the treatment of acute diarrhea and was well tolerated.
给予补液溶液和早期重新喂养可改善腹泻婴幼儿的恢复情况。
本研究旨在评估通过鼻胃管（NGT）在标准高渗溶液（90 mEq/L Na⁺）之后给予低渗溶液（30 mEq/L Na⁺）并随后进行早期重新喂养，以实现急性腹泻婴幼儿更快体重恢复的疗效。
纳入2001年1月至8月在布基纳法索瓦加杜古圣卡米尔医疗中心观察到的年龄小于5岁、患有急性腹泻和脱水（体重减轻≥10%）的婴幼儿。患者被随机分为3种治疗方案之一。A组患者通过NGT先接受高渗溶液补液3小时，随后再接受低渗溶液至少3小时。B组患者仅通过NGT给予低渗溶液。C组患者通过NGT使用高渗溶液进行补液。
共纳入4000例连续接受治疗的婴幼儿（2010例男孩，1990例女孩；平均[标准差]年龄为3.5[2.7]岁）。输注开始后的前6小时，接受联合补液（A组）的患者中有90%体重显著恢复，而B组和C组分别为80%和79%。与B组和C组相比，A组的粪便排出量显著减少（分别为114 g/kg vs 125 g/kg和120 g/kg）。A组仅7%的患者需要用低渗溶液延长补液时间（>6小时），而B组和C组分别为10%和12%。接受联合补液治疗的患者中共有3%需要住院，而B组和C组分别为10%和9%。输注结束时，仅用低渗溶液补液的患者中有25%体重恢复不佳且显得嗜睡，而A组为10%，C组为15%。用高渗溶液补液的患者出现高钠血症症状（血清Na⁺浓度>140 mEq/L）。补液结束时（≥6小时），所有患者均部分或完全恢复了之前的体重，并开始重新喂养。补液和饮食在患者家中继续进行，对于住得较远的患者则在邻近地区继续。
在本研究人群中，先给予高渗溶液再给予低渗溶液并早期重新喂养对急性腹泻的治疗有效且耐受性良好。
