这个孩子是否脱水了?
Michael J Steiner1, Darren A DeWalt, Julie S Byerley
1Department of Pediatrics, University of North Carolina School of Medicine, and Robert Wood Johnson Clinical Scholars Program, Chapel Hill 27599-7593, USA.
JAMA
|June 10, 2004
概括
准确的儿童脱水评估依赖于毛细血管补充时间,皮肤和呼吸模式. 虽然这些症状有助于诊断,但其他测试对精确的脱水评估具有有限的效用.
科学领域:
- 儿科 儿科 儿科
- 紧急医疗 紧急医疗
- 诊断的准确性 诊断的准确性
背景情况:
- 对婴儿和幼儿脱水的快速和准确评估对于适当的治疗和患者处置至关重要.
- 临床评估脱水严重程度指导立即医疗干预.
研究的目的:
- 系统地审查各种临床迹象,症状和用于评估儿科患者脱水的基本实验室测试的精度和准确性.
- 确定个人和综合发现的诊断实用性,用于评估儿童脱水.
主要方法:
- 在MEDLINE (PubMed),Cochrane图书馆和其他来源的综合文献搜索中,发现了1561篇潜在的文章.
- 审查了26项研究,其中包括1个月至5岁儿童脱水诊断结果的原始数据.
- 在最终分析中,包括了13项符合严格诊断准确性标准 (概率比率) 的研究.
主要成果:
- 异常的毛细血管补充时间 (概率率[LR],4.1),皮肤 (LR,2.5),呼吸模式 (LR,2.0) 是5%脱水的最具预测性的个体标志.
- 与单个症状相比,临床检查症状的组合在预测脱水方面显示出明显更高的准确性.
- 患者历史数据和实验室测试在评估脱水严重程度时仅具有中等价值.
结论:
- 对于幼儿脱水的初步临床评估应优先考虑毛细血管补充时间,皮肤和呼吸模式,以及其他症状的组合.
- 当前诊断方法固有的不精确和不准确性限制了临床医生准确量化脱水程度的能力.
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