严重急性营养不良与胃肠炎的静脉补水
Kathryn Maitland1,2, San Maurice Ouattara3,4, Hadiza Sainna5
1Institute of Global Health and Innovation, Department of Surgery and Cancer, Imperial College London, London.
The New England journal of medicine
|June 13, 2025
概括
这项研究发现,对于患有严重急性营养不良和胃肠炎的儿童,口服补水和静脉补水策略之间的死亡率没有显著差异. 这两种方法在96小时后减少死亡时都同样有效.
科学领域:
- 儿科 儿科 儿科
- 传染性疾病 传染性疾病
- 全球健康 全球健康
背景情况:
- 国际指导方针不鼓励在严重急性营养不良的情况下进行静脉注射补水,原因是流体过载的担忧,尽管证据有限.
- 严重急性营养不良的高死亡率需要探索替代的补水策略.
- 目前的建议可能不是最佳的,这促使人们对静脉注射补水的潜在益处进行调查.
研究的目的:
- 在患有严重急性营养不良和胃肠炎的儿童中,比较口服补水的疗效和安全性与快速和缓慢的静脉补水策略.
- 为了评估96小时随机化后死亡的初级终点.
- 在28天的随访期间评估死亡率和严重不良事件.
主要方法:
- 在四个非洲国家进行了一项因数学,开放的优越性试验.
- 患有严重急性营养不良,胃肠炎和脱水的6个月至12岁的儿童被随机分配 (2:1:1) 接受口服补水 (用静脉注射为冲击),快速静脉注射 (3-6小时) 或慢速静脉注射 (8小时) 补水.
- 主要结局是96小时死亡,对死亡率和不良事件进行了长达28天的随访.
主要成果:
- 在口服 (8%) 和静脉注射 (7%) 组之间,96小时的死亡率与口服 (8%) 和静脉注射 (7%) 组相似 (风险比,1.02;95% CI,0.41至2.52).
- 28天后的总死亡率也相似:口服12%与静脉注射10% (危险比,0.85;95% CI,0.41至1.78).
- 在23%的口服组和15-21%的静脉注射组中观察到严重的不良事件,没有证据表明液体过载或相关并发症.
结论:
- 口服和静脉注射补水策略显示,严重急性营养不良和胃肠炎的儿童在96小时死亡率上没有显著差异.
- 静脉注射补水并没有导致死亡率增加或流体过载并发症,这挑战了现有的国际建议.
- 进一步的研究可能会为在这个脆弱的儿科患者群体中进行补水的修订指南提供信息.
相关概念视频
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
92
Enteral nutrition encompasses various methods of delivering nutrition directly to the gastrointestinal (GI) tract, bypassing traditional oral intake. It is particularly beneficial for patients who cannot eat by mouth but have a functioning digestive system. Key methods include nasointestinal feeding, gastrostomy, and jejunostomy, each suited to different clinical scenarios based on the patient's needs and condition.
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
92
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
224
Enteral nutrition delivers nutrients directly to the stomach or small intestine through a tube. This method is appropriate for patients who cannot eat but still have a functioning digestive system. It is also beneficial for individuals with swallowing difficulties, anorexia, malabsorption, or those who have undergone gastrointestinal (GI) surgery.
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
224
01:30Acute Pharyngitis
498
Introduction
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
498
01:18Drugs Affecting GI Tract Motility: Antimicrobials as Antidiarrheal Agents
111
Acute diarrhea, a common gastrointestinal disturbance, is characterized by the rapid evacuation of fluid stools, leading to an excessive weight in fluid. This condition typically arises from disorders affecting intestinal water and electrolyte transport. It can be triggered by an increased osmotic load within the intestine, excessive secretion of electrolytes and water, mucosal exudation of protein and fluid, or altered intestinal motility. The primary risks of acute diarrhea are dehydration...
111
01:25Regulation of Water Intake
486
Osmolality refers to the number of solute particles per kilogram of solvent in a solution. Plasma osmolality specifically indicates the total number of solute particles per kilogram of water in blood plasma. This value reflects the body's hydration status and is tightly regulated through mechanisms controlling water intake and output. While water consumption is a conscious decision, the body has intrinsic regulatory systems to maintain fluid balance. Dehydration, a state of water deficit...
486
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
112
Parenteral Nutrition (PN) delivers essential nutrients directly into the bloodstream, bypassing the digestive system. It is commonly used for individuals with severe digestive disorders or conditions that prevent normal nutrient absorption.
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
112