Oral rehydration therapy in the second decade of the twenty-first century.
Oral rehydration therapy in the second decade of the twenty-first century.
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DOI：
10.1007/s11894-014-0376-2
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发表时间：
2014-03
影响因子：
--
通讯作者：
Young, Graeme P
中科院分区：
文献类型：
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作者：
Binder, Henry J;Brown, Ian;Ramakrishna, B S;Young, Graeme P
大约40年前，口服补液溶液（ORS）被确立为急性感染性腹泻继发脱水治疗的基础。ORS的功效基于葡萄糖通过循环AMP非依赖性过程刺激小肠中钠和液体吸收的能力。尽管已经确定口服补液盐是发展中国家儿童腹泻发病率和死亡率大幅降低的主要原因，但由于许多原因，口服补液盐的使用仍然滞后。这篇综述强调了在证明短链脂肪酸（SCFA）刺激结肠Na和液体吸收的循环AMP独立机制后，建立ORS的主要重新配方的努力。将高直链淀粉玉米淀粉（HAMS）（一种可微生物发酵（或“抗性”）淀粉）添加到ORS中，导致将未吸收的碳水化合物输送到结肠，在结肠中发酵为SCFA。迄今为止，在印度南部进行的三项使用HAMS-ORS的随机对照试验表明，因急性腹泻住院的成人和儿童的腹泻持续时间均显著缩短。目前正在进行重大努力，以建立这种双重作用，改良的HAMS-低渗ORS溶液作为标准ORS治疗急性腹泻脱水。
Oral rehydration solution (ORS) was established as the cornerstone of therapy for dehydration secondary to acute infectious diarrhea approximately 40 years ago. The efficacy of ORS is based on the ability of glucose to stimulate Na and fluid absorption in the small intestine via a cyclic AMP-independent process. Despite the establishment that ORS is the primary reason for the substantial reduction in morbidity and mortality from diarrhea in children in developing countries, the use of ORS has lagged for many reasons. This review highlights efforts to establish a major reformulation of ORS following the demonstration that short-chain fatty acids (SCFA) stimulate colonic Na and fluid absorption by a cyclic AMP-independent mechanism. The addition of high-amylose maize starch (HAMS), a microbially-fermentable (or ‘resistant’) starch, to ORS results in delivery of non-absorbed carbohydrate to the colon where it is fermented to SCFA. To date, three randomized controlled trials with a HAMS-ORS in south India have demonstrated a substantial decrease in diarrhea duration in both adults and children hospitalized for acute diarrhea. Significant efforts are now underway to establish this dual-action, modified HAMS-hypoosmolar ORS solution as the standard ORS for the treatment of dehydration from acute diarrhea.