Duggan C, Refat M, Hashem M, Wolff M, Fayad I, Santosham M
Combined Program in Pediatric GI and Nutrition, Harvard Medical School, Boston, USA.
J Pediatr Gastroenterol Nutr. 1996 Jan;22(1):56-61. doi: 10.1097/00005176-199601000-00009.
Our objective was to determine the ability of several clinical signs of dehydration to distinguish among degrees of dehydration in infants with acute diarrhea. The design was a prospective cohort study in a pediatric referral hospital in Cairo, Egypt. Infant boys, 3-18 months old, with a history of acute diarrhea (5 or more watery stools per day for no more than 7 days) were eligible, except those with frank protein-energy malnutrition, serious nongastrointestinal illness, or being exclusively breast-fed. Several clinical signs of dehydration were assessed upon study entry. Subjects were then rehydrated with an oral rehydration solution and fed a standardized diet until diarrhea ceased (no watery or loose stools for 16 h). The main outcome measure was percent body weight gain at rehydration and at resolution of illness. Data from 135 subjects were available for analysis. Average (SD) rehydration phase duration was 5.2 (2.1) h, and average (SD) duration of illness was 54.5 (38) h. Multiple regression analysis selected prolonged skinfold, altered neurologic status, sunken eyes, and dry oral mucosa as the clinical signs that correlated best with percent dehydration (R2 for model 0.244, p < 0.001). Mean weight gain for the two assessment systems was 3.6-3.9% for mild, 4.9-5.3% for moderate, and 9.5-9.8% for severe dehydration. The most valid clinical signs of dehydration include prolonged skinfold, altered neurologic status, sunken eyes, and dry oral mucosa. Children with clinical signs of mild or moderate dehydration have fluid deficits on the order of 3 or 5% body weight, respectively.
我们的目标是确定几种脱水的临床体征区分急性腹泻婴儿脱水程度的能力。研究设计为在埃及开罗一家儿科转诊医院进行的前瞻性队列研究。纳入标准为3至18个月大、有急性腹泻病史（每天5次或更多水样便，持续不超过7天）的男婴，但患有明显蛋白质-能量营养不良、严重非胃肠道疾病或纯母乳喂养的婴儿除外。研究开始时评估了几种脱水的临床体征。然后让受试者口服补液溶液进行补液，并给予标准化饮食，直至腹泻停止（16小时内无水样便或稀便）。主要结局指标为补液时和疾病痊愈时的体重增加百分比。135名受试者的数据可供分析。补液阶段平均（标准差）持续时间为5.2（2.1）小时，疾病平均（标准差）持续时间为54.5（38）小时。多元回归分析选择皮肤褶皱延长、神经状态改变、眼窝凹陷和口腔黏膜干燥作为与脱水百分比相关性最好的临床体征（模型的R2为0.244，p<0.001）。轻度脱水、中度脱水和重度脱水两种评估系统的平均体重增加分别为3.6 - 3.9%、4.9 - 5.3%和9.5 - 9.8%。最有效的脱水临床体征包括皮肤褶皱延长、神经状态改变、眼窝凹陷和口腔黏膜干燥。有轻度或中度脱水临床体征的儿童分别有大约3%或5%体重的液体 deficit。 （注：原文中“fluid deficits”直译为“液体 deficit”，可能存在拼写错误，根据语境推测可能是“fluid deficits”，意为“液体缺失”，这里保留原文表述。）
