儿童急性腹泻辅助治疗的研究进展

急性腹泻的主要病原体包括细菌、病毒、寄生虫等,它是发展中国家导致儿童死亡的第二原因,占5岁以下儿童死亡率18％.2004年估计有150万儿童死于腹泻,2岁以内儿童腹泻死亡占80％.急性腹泻的治疗目标是防止脱水和营养丢失,并减少腹泻的持续时间和严重程度.世界卫生组织建议使用口服与补液结合的治疗方法.世界胃肠病组织治疗指南认为使用消旋卡多曲可以减少粪便排泄量.推荐的治疗方案是提供口服补液和继续喂养.口服补液有效地减轻脱水,微量营养和益生菌辅助治疗以及止泻剂的应用具有临床治疗效果.本文主要介绍儿童急性腹泻的病原学、流行病学以及辅助治疗的研究进展,为改善及治疗儿童急性腹泻提供参考依据.     

Role of oral rehydration therapy in controlling epidemic of cholera and watery diarrhoea

Oral rehydration therapy (ORT) is basically oral administration of liquid containing various electrolytes in specific proportions to prevent and treat dehydration. This treatment facilitates safe and optimal absorption of water and essential electrolytes such as sodium chloride, sodium bicarbonate and potassium chloride in dehydrated patients. Successful ORT was experienced in cholera patients in Kolkata and Dhaka which was followed by the development of oral rehydration salt (ORS). This procedure can be safely implemented at home. ORT reduced mortality rate both in cholera and non-cholera watery diarrhoea. The various health authorities must support preparedness before pre-positioning of adequate stocks of ORS packets for emergency situations. Health workers should have been the knowledge to prepare ORS solutions.     

Comparative study of rice-based oral rehydration salt solution versus glucose-based oral rehydration salt solution (WHO) in children with acute dehydrating diarrhoea.

One hundred children with acute dehydrating diarrhoea were studied. They were divided into two groups: Group A (n = 50) were given rice-based oral rehydration salt (ORS) solution and group B (n = 50) were given glucose-based ORS solution (WHO). There was no significant decrease in mean stool output and percentage weight gain with rice-based ORS. Both the groups were comparable for volume of ORS solution consumed, time taken for initial rehydration, mean stool output and for correcting biochemical abnormalities.     

Use of oral rehydration therapy in the treatment of childhood diarrhoea in Douala,Cameroon

Introduction

The use of oral rehydration solutions in our context remains limited. This study was conducted to analyze the rate of this use in Douala, Cameroon and thereby determine the factors associated with it.

Method

A cross-sectional survey was administered to parents of children aged five years and younger during a six-month study period. The studied variables focused on the socio-demographic data of the population, data on diarrhoea and its severity, data on oral rehydration salts (ORS), and data related to other interventions for diarrhoea. The chi-square test was used to qualify associations between variables, with the significance level being set at 5%.

Results

Overall, 672 people agreed to participate in the study. Among them, 418 (62.2%) correctly defined diarrhoea. When their children develop diarrhoea, the majority of the parents (348, 51.8%) reported seeking hospital assistance before any intervention, while 225 parents (33.5%) preferred the use of ORS first. Four hundred seventy-five parents (70.7%) had heard of ORS and among them 313 (65.9%) had actually given ORS to their children as treatment during these children''s most recent episodes of diarrhoea. Of the parents who had given their children ORS, 217 (69.3%) knew how to prepare it, and 122 (39.0%) knew how to administer it. One hundred thirty-five parents (20.1%) had administered metronidazole to treat their children''s diarrhoea. The age of the children, the parents'' level of education, and the number of children in the household significantly influenced the use or non-use of ORS (respectively, p < 0.001, p = 0.003 and p < 0.0001). Rehydration was correctly identified by 234 parents (34.8%) as the purpose of administering ORS.

Conclusion

The knowledge and the use of ORS in diarrhoea by the study sample was insufficient. The role of ORS was poorly known. Awareness campaigns can be carried out in order to improve the use of this effective intervention for diarrhoea.     

Efficacy of oral rehydration therapy in dehydrating diarrhoea of children

Establishment of diarrhoea treatment and training units (DTTUs) in all major health facilities for promotion of appropriate oral rehydration therapy (ORT) is an important strategy for control of diarrhoeal diseases (CDD) in children in this country. Univariate analysis of mortality experiences of a random sample of 225 diarrhoea cases among children treated at DTTU in the department of paediatric medicine, RG Kar Medical College, Kolkata revealed that case fatality rate (CFR) of diarrhoea was much higher among children treated with parenteral fluid therapy with or without drugs (20.6% and 20.9% respectively), compared to those treated with oral rehydration solution (ORS) only (0.75%). Certain child care practices, like immunisation, breastfeeding and use of ORS at home also favourably influenced survival of children suffering from diarrhoea. The CFR of diarrhoea cases did not depend on type of diarrhoea or nutritional status of the child. Thus, promotion of correct practice of ORT merits attention through all possible means.     

Study on efficacy of WHO-ORS in malnourished children with acute dehydrating diarrhoea

Twenty-five well nourished children (group A) and 25 malnourished children (group B) of acute diarrhoea with some dehydration were taken up for the study. Both the groups were given World Health Organisation-oral rehydration solution (WHO-ORS) as per WHO guidelines. In both the groups, isonatraemic dehydration was the commonest (group A 64%, group B 56%). Hypokalaemia was noted in 32% cases in group A and 60% cases in group B. Oral rehydration therapy (ORT) was successful in 92% cases in well nourished group A cases and in 80% in group B cases. The mean time in hours required for hydration (group A 8.1+/-1.6; group B 9.1+/-1.4; p<0.05) and hospital stay in days (group A 1.6+/-0.9; group B 3.2+/-3.3; p<0.05) were longer in group B.     

Oral rehydration therapy with particular reference to super ORS

An improved solution of glucose and three salts (ORS) is an elegant and deceptively simple treatment technology to prevent or treat dehydration from diarrhoea. There are many types of formulation tested earlier. First generation improved ORS trials, cereal-based ORS formulations, rice-based ORS trials, glucose-ORS with reduced osmolarity are summarised in the article to have a look of every pros and cons of oral rehydration therapy (ORT). Since the adoption of ORT, estimates of deaths due to diarrhoea in children below 5 years of age have fallen dramatically from 4.6 million in 1980 to 1.8 million in the year 2000.     

消旋卡多曲治疗婴幼儿中重型急性水样腹泻

目的探讨消旋卡多曲治疗婴幼儿中、重型急性水样腹泻的疗效和安全性。方法选择符合条件的3～36个月的中、重型急性水样腹泻患儿共78例,按随机编号分别给予消旋卡多曲和安慰剂,医生和家长均不知何种治疗方案。记录治疗期间患儿腹泻次数、ORS摄入量、静脉补液量、脱水纠正时间。治疗72h时判定疗效。结果共有73例患儿完成本实验,破盲分析,治疗组大便次数、摄入ORS量、静脉补液量、脱水纠正时间均明显低于对照组(P<0.01)。治疗组总有效率88.9%,显著高于对照组的64.9%(P<0.05)。结论消旋卡多曲治疗婴幼儿中、重型急性水样腹泻能明显减少患儿大便次数,降低ORS和静脉补液量,迅速纠正脱水,且未发现与药物有关的不良反应,安全性高。     

消旋卡多曲治疗婴幼儿中重型急性水样腹泻

目的探讨消旋卡多曲治疗婴幼儿中、重型急性水样腹泻的疗效和安全眭。方法选择符合条件的3—36个月的中、重型急性水样腹泻患儿共78例，按随机编号分别给予消旋卡多曲和安慰剂，医生和家长均不知何种治疗方案。记录治疗期间患儿腹泻次数、ORS摄入量、静脉补液量、脱水纠正时间。治疗72h时判定疗效。结果共有73例患儿完成本实验，破盲分析，治疗组大便次数、摄入ORS量、静脉补液量、脱水纠正时间均明显低于对照组（P〈0．01）。治疗组总有效率88．9％，显著高于对照组的64．9％（P〈0．05）。结论消旋卡多曲治疗婴幼儿中、重型急性水样腹泻能明显减少患儿大便次数，降低ORS和静脉补液量，迅速纠正脱水，且未发现与药物有关的不良反应，安全性高。     

Oral rehydration therapy

This paper discusses the use of oral rehydration therapy (ORT) in the clinical management of diarrhea with no dehydration, diarrhea with some dehydration, and diarrhea with severe dehydration. The 1st step in ORT is to weigh the patient and assess the degree of dehydration. It should be recognized that a child who has had 4 loose stools in the past 24 hours and is thirsty has some degree of dehydration, and ORT should start as soon as possible. If the child has no signs of dehydration, the mother should be given 3 instructions for treating diarrhea at home: 1) give the child more fluids more often; 2) continue to breastfeed; and 3) return the child to the clinic if he develops signs of dehydration, if the diarrhea gets worse, or if he is not better after 2 days. If a child has 2 or more of the signs of some dehydration (4-10 loose stools/day, more than a little vomiting, thirstiness, and less urine than usual), he should be rehydrated with oral rehydration solution (ORS). If available, the World Health Organization ORS packets should be used. After the child has been given 10-20 ml/kg of ORS each hour for 4 hours, the hydration should be reassessed. ORS should be given for each loose stool. If the child has 2 or more of the signs of severe dehydration (more than 10 loose stools/day, much vomiting, inability to drink fluids, and no urine for 6 hours), intravenous rehydration is necessary. A major problem with use of ORS is the time involved to explain the process to parents. Parents must understand that ORS does not treat the diarrhea per se; rather, it replaces fluids and salts lost by the child and prevents dehydration. If parents do not understand this, they may become discouraged if the diarrhea continues and stop ORT. ORT is as effective in treating adults with diarrhea as it is in children. In addition, ORT is just as good as intravenous rehydration, except in cases where the dehydration is severe.     

口服补液盐治疗成人急性感染性腹泻脱水的效果分析

目的探讨口服补液盐（ORS）治疗成人急性腹泻患者补液治疗的临床效果。方法136例成人急性腹泻患者被纳入研究,69例随机分入口服补液治疗组（ORT组）,临床评估为轻、中度脱水的患者采用ORS治疗,重度脱水患者早期采取静脉和ORS联合治疗,恢复至轻中度脱水后仅服用ORS。67例随机进入静脉输液组（IVT组）,采用静脉补液治疗脱水。补液以外的其他治疗两组相似。比较两组患者的临床转归。结果ORT组和IVT组在临床脱水纠正率、腹泻好转时间、不同时间电解质和酸碱紊乱恢复率间差异无统计学意义（P〉0．05）。结论ORS治疗成人急性腹泻脱水患者安全有效、简便易行,能在很大程度上减少静脉输液使用率。     

2. Acute infectious diarrhoea and dehydration in children

Gastroenteritis in children is still a common reason for consulting a general practitioner and for hospital admission. Rotavirus is the most common cause of gastroenteritis in children and accounts for half of all hospital admissions for severe acute infectious diarrhoea. Most children with gastroenteritis do not develop dehydration and can be treated at home. Children with mild to moderate dehydration should be treated with low osmolarity oral rehydration solutions, and those with severe dehydration or shock need to be admitted for administration of intravenous fluids. Lactose-free feeds should not be routinely used after acute gastroenteritis, but there is some evidence that a lactose-free diet may reduce the duration of diarrhoea. Antimotility drugs are rarely indicated in children with gastroenteritis, as the potential risks outweigh the benefits. The development of a rotavirus vaccine would provide huge public health benefits and cost savings. Other preventive strategies include educating people about personal and food hygiene and encouraging breastfeeding.     

Evolution in the recommendations for oral rehydration therapy according to World Health Organisation guidelines: where to go from here?

Guidelines on the use of oral rehydration salts (ORS) have been revised over the years based on evidence from research studies and clinical experience. This paper charts the evolution in oral rehydration therapy (ORT) in the context of World Health Organisation (WHO) recommendations. Diarrhoeal disease case management, with ORT as its cornerstone, has had tremendous success in terms of implementation and outcome. To further decrease global diarrhoeal morbidity and mortality, there should be increased efforts to accelerate the introduction of safe, effective, and affordable against diarrhoeal pathogens such as cholera and rotavirus.     

History of the development of oral rehydration fluids

The development of oral rehydration fluid for the treatment of cholera and other diarrhoeal diseases has been regarded as one of the most important medical advances of the last century. This article summarises information on how this achievement was made possible. The development is traced from the historical empiric use of oral fluids for treating diarrhoea, to physiologic studies in animals that defined how glucose and sodium were coupled in absorption by the small intestine and finally, to the use of this knowledge in developing the simple effective solutions that were adopted by WHO as the mainstay of diarrhoeal therapy worldwide.     

口服补液治疗小儿急性腹泻的临床观察

目的：比较口服补液盐与米汁在小儿急性腹泻的临床疗效。方法：60名急性腹泻患儿随机分为2组．在两组均予抗病毒及思密达治疗的同时，A组加服口服补液盐（ORS），B组予米汁。结果：24h后A组93．3％的患儿纠正了脱水，B组为73．3％；72h后疗效比较B组大便次数减少优于A组，差异均有统计学意义。结论：ORS对小儿急性腹泻轻、中度脱水的治疗优于传统的米汁，而米汁较ORS更能有效的减少大便次数。     

Progress in the prevention and control of diarrhoeal diseases since Independence

Acute diarrhoeal diseases constitute one of the major health problems among young children in India. It was estimated in 1978 that 1.5 million children under the age of 5 years die due to diarrhoea every year, which declined to 0.6-0.7 million in the estimate revised in 1992. A similar declining trend has also been noted in hospitalized cases in Calcutta (present Kolkata) during 1980-95 as well as from other parts of India. Even today, cholera epidemics occur regularly in India. The cholera epidemic caused by a novel strain of Vibrio cholerae, designated as V. cholerae 0139 Bengal in 1992 and multidrug-resistant shigellosis in eastern India in 1984 are matters of grave concern. The launching of the National Diarrhoeal Diseases Control Programme (CDD) in 1978, based on a three-tier approach, is of great importance. The rate of use of oral rehydration salt (ORS) solution and oral rehydration therapy (ORT) remain suboptimal in India. In spite of the launching of the 'Ganga Action Plan' and the 'National River Action Plan', India faces a major problem of diarrhoeal diseases. Lack of safe water supply, poor environmental sanitation, improper disposal of human excreta and poor personal hygiene help to perpetuate and spread diarrhoeal diseases in India. Since diarrhoeal diseases are caused by 20-25 pathogens, vaccination, though an attractive disease prevention strategy, is not feasible. However, as the majority of childhood diarrhoeas are caused by V. cholerae, Shigellae dysenteriae type 1, rotavirus and enterotoxigenic Escherichia coli (E. coli) which have a high morbidity and mortality, vaccines against these organisms are essential for the control of epidemics. A strong political will with appropriate budgetary allocation is essential for the control of childhood diarrhoeal diseases in India, a formidable task in a country with a population of over 1 billion.     

小儿口服补液盐(ORS)的临床应用及配制方法

目的 :腹泻的主要危害是引起患儿的脱水、电解质紊乱而死亡。 2 0多年来WHO和UNICEF一直主张并推广临床采取口服补液盐 (oralrehydrationsalts简称ORS)进行口服补液盐疗法 (oralrehydrationtherapy简称ORT)来防治腹泻引起的脱水。方法 :通过我科 2 0 0 1年至 2 0 0 3年门诊日志 14 6例小儿腹泻 (轻型 4 4例 ,中型 10 2例 )接受ORT的使用后 ,均在短时间内恢复健康。结果 :临床上进一步扩大ORT的使用后 ,有效地减少了腹泻死亡的危险性 ,对改善儿童健康状况起到了重要作用。     

Control of diarrhoeal disease in Tonga 1978-83

Tonga, like many developing countries, suffers from a shortage of medical staff and a high morbidity and mortality from paediatric diarrhoeal disease. In 1980 a programme was started to train medical assistants and village administrators in the correct use of oral rehydration salt solution for rehydration. The effect on morbidity, mortality, and admission to hospital over the six years 1978-83 was assessed. After the introduction of the scheme the number of deaths due to diarrhoea fell considerably and the state of hydration in children admitted to hospital with diarrhoea greatly improved. It is recommended that similar programmes be adopted where clinical problems of diarrhoea with dehydration persist. Instruction in the use of oral rehydration fluid was most effectively given by non-medical staff to groups of mothers, rather than by paediatricians in their inevitably brief, although important, explanation given in hospital.     

泉州地区1962-2010年霍乱弧菌菌型变迁及耐药性研究

目的了解泉州地区历年霍乱菌型变迁及药物耐药性,为霍乱防治工作提供参考。方法对泉州地区1962-2010年霍乱流行疫情资料进行回顾性分析;采用WHO推荐的改良K-B纸片法,对部分菌株进行抗菌药物的药敏试验。结果 1962-2010年,泉州共发生4次较大规模的霍乱流行,流行菌型由O1小川型与O1稻叶型交替进行。大多数霍乱弧菌对诺氟沙星和环丙沙星敏感,敏感率分别为92.31%和99.20%;磺胺类药物敏感性逐年降低,对其它抗菌药耐药;O139群霍乱弧菌的耐药性明显高于O1群霍乱弧菌,不同年份的菌株耐药的程度不一致。结论泉州地区霍乱流行优势菌型为O1群霍乱弧菌,由小川型与稻叶型交替进行;霍乱弧菌对抗菌药物的敏感性逐渐下降。     

Honey in the treatment of infantile gastroenteritis

A clinical study was undertaken using honey in oral rehydration solution in infants and children with gastroenteritis. The aim was to evaluate the influence of honey on the duration of acute diarrhoea and its value as a glucose substitute in oral rehydration. The results showed that honey shortens the duration of bacterial diarrhoea, does not prolong the duration of non-bacterial diarrhoea, and may safely be used as a substitute for glucose in an oral rehydration solution containing electrolytes. The correct dilution of honey, as well as the presence of electrolytes in the oral rehydration solution, however, must be maintained.