Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis.
Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis.
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DOI：
10.1186/s12887-018-1006-1
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发表时间：
2018-02-09
期刊：
影响因子：
2.4
通讯作者：
Maitland K
中科院分区：
文献类型：
--
作者：
Iro MA;Sell T;Brown N;Maitland K
世界卫生组织（世卫组织）建议快速静脉补液，在3-6小时内使用70-100毫升/公斤的液体量，并迅速给予一些初始体积作为初始液体丸，以治疗急性胃肠炎（AGE）和严重脱水儿童的低血容量性休克。支持快速补液和慢速补液的安全性和有效性的证据仍不确定。我们于2017年5月11日对随机对照试验（RCTs）进行了系统回顾，使用标准搜索词比较了AGE和中度或重度脱水儿童静脉输液治疗的不同比率。两位作者独立评估试验质量并提取数据。非随机对照试验和非英文文章被排除。主要终点是死亡率，次要终点包括不良事件（安全性）和治疗有效性。在最初确定的1390项研究中，有18项被评估为合格。其中，3项研究（n = 464）符合纳入的先验标准；大多数被研究的儿童患有中度脱水，没有一个是在资源贫乏的环境中进行的。在1-2小时（快速）和2-4小时（慢速）的时间内，液体替换的体积和速率从20到60 ml/kg不等。这些研究在方法学上存在很大的异质性，只有一项研究被认为是高质量的。在任何研究中都没有死亡病例。安全性终点仅确定水肿（n = 6）和钠血症（n = 2）。合并分析显示，快速和缓慢静脉补液组治疗失败比例（N = 468）：合并RR为1.30 (95% CI: 0.87, 1.93)，再入院率（N = 439）：合并RR为1.39 (95% CI: 0.68, 2.85)，差异无统计学意义。尽管广泛实施了世卫组织针对严重AGE的C计划指南，但我们发现在资源有限的环境中没有进行临床评估，并且在世界其他地区仅对补液率和补液量进行了有限的评估。最近对剧烈液体膨胀的担忧需要进一步研究，以指导严重AGE的静脉补液治疗率。本文的在线版本（10.1186/ s128887 -018-1006-1）包含补充内容，仅供授权用户使用。
The World Health Organization (WHO) recommends rapid intravenous rehydration, using fluid volumes of 70-100mls/kg over 3–6 h, with some of the initial volume given rapidly as initial fluid boluses to treat hypovolaemic shock for children with acute gastroenteritis (AGE) and severe dehydration. The evidence supporting the safety and efficacy of rapid versus slower rehydration remains uncertain. We conducted a systematic review of randomised controlled trials (RCTs) on 11th of May 2017 comparing different rates of intravenous fluid therapy in children with AGE and moderate or severe dehydration, using standard search terms. Two authors independently assessed trial quality and extracted data. Non-RCTs and non-English articles were excluded. The primary endpoint was mortality and secondary endpoints included adverse events (safety) and treatment efficacy. Of the 1390 studies initially identified, 18 were assessed for eligibility. Of these, 3 studies (n = 464) fulfilled a priori criteria for inclusion; most studied children with moderate dehydration and none were conducted in resource-poor settings. Volumes and rates of fluid replacement varied from 20 to 60 ml/kg given over 1-2 h (fast) versus 2-4 h (slow). There was substantial heterogeneity in methodology between the studies with only one adjudicated to be of high quality. There were no deaths in any study. Safety endpoints only identified oedema (n = 6) and dysnatraemia (n = 2). Pooled analysis showed no significant difference between the rapid and slow intravenous rehydration groups for the proportion of treatment failures (N = 468): pooled RR 1.30 (95% CI: 0.87, 1.93) and the readmission rates (N = 439): pooled RR 1.39 (95% CI: 0.68, 2.85). Despite wide implementation of WHO Plan C guideline for severe AGE, we found no clinical evaluation in resource-limited settings, and only limited evaluation of the rate and volume of rehydration in other parts of the world. Recent concerns over aggressive fluid expansion warrants further research to inform guidelines on rates of intravenous rehydration therapy for severe AGE. The online version of this article (10.1186/s12887-018-1006-1) contains supplementary material, which is available to authorized users.
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