Sublingual sugar for hypoglycaemia in children with severe malaria: a pilot clinical study.
Sublingual sugar for hypoglycaemia in children with severe malaria: a pilot clinical study.
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DOI：
10.1186/1475-2875-7-242
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发表时间：
2008-11-23
期刊：
影响因子：
3
通讯作者：
Barennes H
中科院分区：
文献类型：
--
作者：
Graz B;Dicko M;Willcox ML;Lambert B;Falquet J;Forster M;Giani S;Diakite C;Dembele EM;Diallo D;Barennes H
低血糖是严重疟疾的不良预后指标。静脉输注在农村地区很少可行。在一项针对马里患有严重疟疾的低血糖儿童的随机对照试验中，对舌下糖（SLS）的疗效进行了评估。在151例假定患有严重疟疾的患者中，23名血糖浓度< 60 mg/dl （< 3.3 mmol/l）的儿童被随机分配接受静脉注射10%葡萄糖（IVG, n = 9）或舌下糖（SLS, n = 14）。在SLS中，每20分钟将一茶匙糖，用几滴水湿润，轻轻地放在舌下。孩子被置于恢复体位。在第一个小时内每5-10分钟测量一次血糖浓度（BGC）。所有儿童都用肌注蒿甲醚治疗疟疾。主要结局指标是治疗反应，定义为入院后40分钟内BGC达到>= 3.3 mmol/l （60 mg/dl）。次要结局指标为20分钟的早期治疗反应、复发（早期和晚期）、最大BGC增益（CGmax）和治疗延迟。两组在主要结局指标上无显著差异。SLS和IVG的治疗有效率分别为71%和67%。在应答者中，SLS治疗40分钟复发率为30%，IVG治疗20分钟复发率为17%。每组有一人死亡。SLS组的治疗失败与儿童咬牙或吞咽糖有关，而IVG组的治疗失败是由于不可避免的延迟开始输注（中位时间17.5分钟（范围3-40））。在SLS患者中，9名真正保持舌下血糖的患者BGC上升迅速。除一人外，所有人的BGC都增加了10分钟，平均增加了44 mg/dl （95%CI: 20.5-63.4）。舌下糖似乎是一种儿童友好，耐受性好，有效的有希望的方法，提高血糖的重症儿童。需要更频繁地重复给药以防止复发。应监测儿童是否过早吞咽导致吸收延迟，在这种情况下，应给予另一剂量的糖。在等待静脉注射葡萄糖时，舌下糖可以作为立即的“急救”措施。在许多情况下，它可以避免静脉注射葡萄糖的需要。
Hypoglycaemia is a poor prognostic indicator in severe malaria. Intravenous infusions are rarely feasible in rural areas. The efficacy of sublingual sugar (SLS) was assessed in a pilot randomized controlled trial among hypoglycaemic children with severe malaria in Mali. Of 151 patients with presumed severe malaria, 23 children with blood glucose concentrations < 60 mg/dl (< 3.3 mmol/l) were assigned randomly to receive either intravenous 10% glucose (IVG; n = 9) or sublingual sugar (SLS; n = 14). In SLS, a teaspoon of sugar, moistened with a few drops of water, was gently placed under the tongue every 20 minutes. The child was put in the recovery position. Blood glucose concentration (BGC) was measured every 5–10 minutes for the first hour. All children were treated for malaria with intramuscular artemether. The primary outcome measure was treatment response, defined as reaching a BGC of >= 3.3 mmol/l (60 mg/dl) within 40 minutes after admission. Secondary outcome measures were early treatment response at 20 minutes, relapse (early and late), maximal BGC gain (CGmax), and treatment delay. There was no significant difference between the groups in the primary outcome measure. Treatment response occurred in 71% and 67% for SLS and IVG, respectively. Among the responders, relapses occurred in 30% on SLS at 40 minutes and in 17% on IVG at 20 minutes. There was one fatality in each group. Treatment failures in the SLS group were related to children with clenched teeth or swallowing the sugar, whereas in the IVG group, they were due to unavoidable delays in beginning an infusion (median time 17.5 min (range 3–40). Among SLS, the BGC increase was rapid among the nine patients who really kept the sugar sublingually. All but one increased their BGC by 10 minutes with a mean gain of 44 mg/dl (95%CI: 20.5–63.4). Sublingual sugar appears to be a child-friendly, well-tolerated and effective promising method of raising blood glucose in severely ill children. More frequent repeated doses are needed to prevent relapse. Children should be monitored for early swallowing which leads to delayed absorption, and in this case another dose of sugar should be given. Sublingual sugar could be proposed as an immediate "first aid" measure while awaiting intravenous glucose. In many cases it may avert the need for intravenous glucose.
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