Hoxha Teuta, Xhelili Luan, Azemi Mehmedali, Avdiu Muharrem, Ismaili-Jaha Vlora, Efendija-Beqa Urata, Grajcevci-Uka Violeta
Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo.
Department of Pediatrics, University Hospital Centre "Mother Teresa", Tirana, Albania.
Med Arch. 2015 Feb;69(1):10-2. doi: 10.5455/medarh.2015.69.10-12. Epub 2015 Feb 21.
Acute evaluation and treatment of children presenting with dehydration represent one of the most common situation in the pediatric emergency department. To identify dehydration in infants and children before treatment, a number of symptoms and clinical signs have been evaluated. The aim of the study was to describe the performance of clinical signs in detecting dehydration in children.
Two hundred children aged 1 month to 5 year were involved in our prospective study. The clinical assessment consisted of the ten clinical signs of dehydration, including those recommended by WHO (World Health Organization), heart rate, and capillary refill time.
Two hundred patients with diarrhea were enrolled in the study. The mean age was 15.62±9.03 months and 57.5% were male. Of these 121 had a fluid deficit of < 5%, 68 had a deficit of 5 to 9% and 11(5.5%) had a deficit of 10% or more. Patients classified as having no or mild, moderate, and severe dehydration were found to have the following respective gains in percent weight at the end of illness: 2.44±0.3, 6.05± 1.01 and, 10.66± 0.28, respectively. All clinical signs were found more frequently with increasing amounts of dehydration(p<0.001, One-way ANOVA). The median number of findings among subjects with no or mild dehydration (deficit <5%) was 3; among those with moderate dehydration (deficit 5% to 9%) was 6.5 and among those with severe dehydration (deficit >10%) the median was 9 (p<0.0001, Kruskal-Wallis test). Using stepwise linear regression and a p value of <0.05 for entry into the model, a four-variable model including sunken eyes, skin elasticity, week radial pulse, and general appearance was derived.
None of the 10 findings studied, is sufficiently accurate to be used in isolation. When considered together, sunken eyes, decreased skin turgor, weak pulse and general appearance provide the best explanatory power of the physical signs considered.
对出现脱水症状的儿童进行急性评估和治疗是儿科急诊科最常见的情况之一。为了在治疗前识别婴幼儿的脱水情况，人们对多种症状和临床体征进行了评估。本研究的目的是描述临床体征在检测儿童脱水方面的表现。
200名年龄在1个月至5岁的儿童参与了我们的前瞻性研究。临床评估包括十种脱水临床体征，其中包括世界卫生组织（WHO）推荐的体征、心率和毛细血管再充盈时间。
200例腹泻患者纳入研究。平均年龄为15.62±9.03个月，57.5%为男性。其中，121例液体缺失<5%，68例缺失5%至9%，11例（5.5%）缺失10%或更多。被分类为无脱水或轻度、中度和重度脱水的患者在疾病末期体重增加的百分比分别为：2.44±0.3、6.05±1.01和10.66±0.28。随着脱水程度的增加，所有临床体征出现的频率更高（p<0.001，单因素方差分析）。无脱水或轻度脱水（缺失<5%）的受试者中发现的体征中位数为3；中度脱水（缺失5%至9%）的受试者中为6.5；重度脱水（缺失>10%）的受试者中中位数为9（p<0.0001，Kruskal-Wallis检验）。使用逐步线性回归并将进入模型的p值设为<0.05，得出了一个包含眼窝凹陷、皮肤弹性、桡动脉搏动微弱和总体外观的四变量模型。
所研究的10种体征中，没有一种足够准确到可以单独使用。综合考虑时，眼窝凹陷、皮肤弹性降低、脉搏微弱和总体外观对所考虑的体征具有最佳的解释力。
