Mackenzie A, Barnes G, Shann F
Department of Gastroenterology and Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia.
Lancet. 1989 Sep 9;2(8663):605-7. doi: 10.1016/s0140-6736(89)90723-x.
102 children with acute gastroenteritis were thought by the admitting junior doctors to be 5% or more dehydrated. As judged by subsequent weight recovery in hospital, the main indicators of mild to moderate dehydration were decreased peripheral perfusion, deep breathing, decreased skin turgor, high urea, low pH, and a large base deficit; a history of increased thirst was just short of statistical significance. Dehydration was not indicated by a history of oliguria, by the presence of restlessness or lethargy, sunken eyes, dry mouth, or a sunken fontanelle or by the absence of tears. Clinical signs of dehydration became apparent at 3-4% rather than 5% dehydration. The degree of dehydration was overestimated by a mean of 3.2%; this caused unnecessary hospital admissions and overtreatment with intravenous fluid.
收治的低年资医生认为，102例急性肠胃炎患儿存在5%或更高程度的脱水。根据随后在医院的体重恢复情况判断，轻度至中度脱水的主要指标为外周灌注减少、呼吸加深、皮肤弹性降低、尿素升高、pH值降低和碱剩余负值增大；口渴增加的病史仅略低于统计学显著性。少尿病史、烦躁或嗜睡、眼窝凹陷、口干、囟门凹陷或无泪等情况均不能提示脱水。脱水的临床体征在脱水3%-4%时而非5%时才会明显显现。脱水程度平均被高估了3.2%；这导致了不必要的住院治疗和静脉输液过度治疗。
