果汁、其它饮料可以处理孩子的轻度胃肠炎


  【24drs.com】根据在线发表于4月30日JAMA期刊的研究结果,对于轻度的小儿肠胃炎治疗,简单的方法,如稀释苹果汁,可能比电解质溶液更有效。
  
  Stephen B. Freedman等人报告指出,加拿大647名孩童的研究中,经历一些治疗失败的轻度胃肠炎和最轻微脱水的患者,给予他们偏好的饮料后提供半强度的苹果汁时,效果和给予标准电解质溶液维持治疗的孩童相当;这些结果挑战了「当开始腹泻时例行性给予电解质维持溶液」的建议。
  
  加拿大Alberta Calgary大学Alberta儿童医院研究中心小儿部、急诊医学科暨胃肠科Freedman医师等人,将2010至2015年当年10月到隔年4月间,因轻度胃肠炎急诊的孩童纳入研究。符合条件的患者年龄为6-60个月、体重至少8公斤,在过去24小时曾发生至少3次呕吐或腹泻,且症状持续未超过96小时。
  
  这些孩童的平均年龄为28.3个月(标准差为15.9个月),其中331名为男童。研究者随机指定孩童接受半强度的苹果汁或苹果口味的电解质维持溶液,每2-5分钟各给予5-mL的前述液体,呕吐的孩童另给予ondansetron治疗。
  
  出院后,研究组的孩童可以给予他们喜好的液体,如果汁、牛奶、或运动饮料。对照组的孩童继续接受电解质维持溶液取代所有流失的液体。照护者依照指示提供指定的液体,每次呕吐时给予2 mL/kg之量、腹泻时给予10 mL/kg之量。他们还收到日记,要求要记录症状频率和追踪回诊时的详细资料。
  
  接受果汁和偏好之液体的323名孩童中,54人(16.7%)经历过某种的治疗失败(95%信赖区间[CI]为12.8% - 21.2%),而接受电解质溶液治疗的324名孩童有81人失败(25.0%;95% CI, 20.4% - 30.1%;P < .001)。治疗失败的定义为,在纳入研究的7天内,使用静脉输液、住院或意外提早就医、症状持续、交替发生、或体重减轻3%或其它严重脱水症状。
  
  次级结果包括静脉补液和住院,使用电解质溶液组的孩童比较常发生。苹果汁/偏好的液体组的孩童中,有8人需要静脉补液(2.5%;95% CI, 1.1% - 4.8%),电解质溶液组有29名孩童需要(9.0%;95% CI, 6.1% - 12.6%;P = .001)。
  
  作者们认为,苹果汁组的孩童比接受电解质溶液的孩童更愿意喝他们的液体补充品,可能是因为电解质溶液比较不可口,即便它有添加蔗糖或苹果风味了。24个月以上的孩童从苹果汁/偏好饮料的介入方式获得最大好处。
  
  有关医师对苹果汁和其它果汁中含糖量的顾虑,作者们写道,目前研究中发生的腹泻,尽管苹果汁/偏好液体组中允许使用高糖液体,两组之间并无显著差异。这些结果为最轻微脱水的孩童提供了务实的证据,促进液体摄取比葡萄糖负载消耗更重要。至于低钠血症的发生方面,并不显著。
  
  作者们提醒,因为是在高收入国家进行这篇研究,研究结果无法推论到胃肠炎相关并发症风险更高之中低收入国家的孩童,目前也还不清楚这些结果是否可以一般化到可能使用其它类型电解质维持溶液的其它对象。
  
  他们结论表示,在许多高收入国家,对于轻度肠胃炎与最轻微脱水的孩童,使用稀释的苹果汁和偏好的液体可能是替代电解质维持溶液的适当方法。
  
  资料来源:http://www.24drs.com/
  
  Native link:Juice, Other Drinks Can Manage Mild Gastroenteritis in Children

Juice, Other Drinks Can Manage Mild Gastroenteritis in Children

By Norra MacReady
Medscape Medical News

Simple remedies such as dilute apple juice may be more effective than an electrolyte solution for treating mild pediatric gastroenteritis, according to findings published online April 30 in JAMA.

In a study of 647 children in Canada, patients with mild gastroenteritis and minimal dehydration experienced fewer treatment failures when offered half-strength apple juice followed by their preferred drinks compared with children given a standard electrolyte maintenance solution, report Stephen B. Freedman, MDCM, and colleagues.

"These results challenge the recommendation to routinely administer electrolyte maintenance solution when diarrhea begins," they write.

Dr Freedman, from the Section of Emergency Medicine and the Section of Gastroenterology, Department of Pediatrics, and Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada, and coauthors enrolled children who presented to the emergency room with symptoms of mild gastroenteritis between October and April of the 2010 to 2015 calendar years. Eligible patients were 6 to 60 months of age, weighed at least 8 kg, and had had at least three episodes of vomiting or diarrhea within the previous 24 hours, with symptoms lasting no more than 96 hours.

The children had a mean age of 28.3 months (standard deviation, 15.9 months) and included 331 boys. The investigators randomly assigned children to receive half-strength apple juice or an apple-flavored electrolyte maintenance solution, with each fluid administered in 5-mL aliquots every 2 to 5 minutes. Children who vomited received ondansetron.

After discharge, children in the study group could receive their preferred fluids such as juice, milk, or sports drinks. Children in the control group continued to receive the electrolyte maintenance solution to replace all fluid losses. Caregivers were instructed to provide the designated fluid in a dose of 2 mL/kg per vomiting episode and 10 mL/kg per episode of diarrhea. They also received diaries and were asked to record details such as symptom frequency and follow-up clinicians' visits.

Of 323 children who received juice and preferred fluids, 54 (16.7%) experienced some form of treatment failure (95% confidence interval [CI], 12.8% - 21.2%) compared with 81 of 324 children treated with the electrolyte solution (25.0%; 95% CI, 20.4% - 30.1%; P < .001). Treatment failure was defined as a composite of intravenous rehydration, hospitalization or an unscheduled physician visit, protracted symptoms, crossover, or loss of 3% of body weight or other symptom of significant dehydration, occurring within 7 days of enrolment.

Secondary outcomes, including intravenous rehydration and hospitalization, were more frequent among children treated with the electrolyte solution. Intravenous rehydration was required by eight children in the apple juice/preferred fluids group (2.5%; 95% CI, 1.1% - 4.8%) and 29 children in the electrolyte solution group (9.0%; 95% CI, 6.1% - 12.6%; P = .001).

The authors suggest that children in the apple juice group were more willing to drink their fluids than the children receiving the electrolyte solution, which was probably less palatable despite the addition of sucralose and apple flavoring. Children older than 24 months derived the greatest benefit from the apple juice/preferred beverage intervention.

For clinicians concerned about the sugar content in apple and other juices, episodes of diarrhea in the current study were "not significantly different between study groups despite the permitted use of high-glucose fluids in the apple juice/preferred fluids group," the authors write. "These results provide pragmatic evidence that in children with minimal dehydration, promoting fluid consumption is more important than glucose load consumed." They observed no significant episodes of hyponatremia.

The authors did caution that because the study was conducted in a high-income nation, the findings cannot be extrapolated to children in middle- and low-income countries, who are at higher risk for complications related to gastroenteritis. It is also not clear whether the results can be generalized to other settings that may use other types of electrolyte maintenance solutions.

"In many high-income countries, the use of dilute apple juice and preferred fluids may be an appropriate alternative to electrolyte maintenance solution use in children with mild gastroenteritis and minimal dehydration," they conclude.

The authors have disclosed no relevant financial relationships.

JAMA. Published online April 30, 2016. Full text

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电解质口服液有助于急性小儿科肠胃炎
2003/1/14 上午 09:39:00

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