果汁、其他飲料可以處理孩子的輕度胃腸炎


  【24drs.com】根據線上發表於4月30日JAMA期刊的研究結果,對於輕度的小兒腸胃炎治療,簡單的方法,如稀釋蘋果汁,可能比電解質溶液更有效。
  
  Stephen B. Freedman等人報告指出,加拿大647名孩童的研究中,經歷一些治療失敗的輕度胃腸炎和最輕微脫水的患者,給予他們偏好的飲料後提供半強度的蘋果汁時,效果和給予標準電解質溶液維持治療的孩童相當;這些結果挑戰了「當開始腹瀉時例行性給予電解質維持溶液」的建議。
  
  加拿大Alberta Calgary大學Alberta兒童醫院研究中心小兒部、急診醫學科暨胃腸科Freedman醫師等人,將2010至2015年當年10月到隔年4月間,因輕度胃腸炎急診的孩童納入研究。符合條件的患者年齡為6-60個月、體重至少8公斤,在過去24小時曾發生至少3次嘔吐或腹瀉,且症狀持續未超過96小時。
  
  這些孩童的平均年齡為28.3個月(標準差為15.9個月),其中331名為男童。研究者隨機指定孩童接受半強度的蘋果汁或蘋果口味的電解質維持溶液,每2-5分鐘各給予5-mL的前述液體,嘔吐的孩童另給予ondansetron治療。
  
  出院後,研究組的孩童可以給予他們喜好的液體,如果汁、牛奶、或運動飲料。對照組的孩童繼續接受電解質維持溶液取代所有流失的液體。照護者依照指示提供指定的液體,每次嘔吐時給予2 mL/kg之量、腹瀉時給予10 mL/kg之量。他們還收到日記,要求要記錄症狀頻率和追蹤回診時的詳細資料。
  
  接受果汁和偏好之液體的323名孩童中,54人(16.7%)經歷過某種的治療失敗(95%信賴區間[CI]為12.8% - 21.2%),而接受電解質溶液治療的324名孩童有81人失敗(25.0%;95% CI, 20.4% - 30.1%;P < .001)。治療失敗的定義為,在納入研究的7天內,使用靜脈輸液、住院或意外提早就醫、症狀持續、交替發生、或體重減輕3%或其他嚴重脫水症狀。
  
  次級結果包括靜脈補液和住院,使用電解質溶液組的孩童比較常發生。蘋果汁/偏好的液體組的孩童中,有8人需要靜脈補液(2.5%;95% CI, 1.1% - 4.8%),電解質溶液組有29名孩童需要(9.0%;95% CI, 6.1% - 12.6%;P = .001)。
  
  作者們認為,蘋果汁組的孩童比接受電解質溶液的孩童更願意喝他們的液體補充品,可能是因為電解質溶液比較不可口,即便它有添加蔗糖或蘋果風味了。24個月以上的孩童從蘋果汁/偏好飲料的介入方式獲得最大好處。
  
  有關醫師對蘋果汁和其他果汁中含糖量的顧慮,作者們寫道,目前研究中發生的腹瀉,儘管蘋果汁/偏好液體組中允許使用高糖液體,兩組之間並無顯著差異。這些結果為最輕微脫水的孩童提供了務實的證據,促進液體攝取比葡萄糖負載消耗更重要。至於低鈉血症的發生方面,並不顯著。
  
  作者們提醒,因為是在高收入國家進行這篇研究,研究結果無法推論到胃腸炎相關併發症風險更高之中低收入國家的孩童,目前也還不清楚這些結果是否可以一般化到可能使用其他類型電解質維持溶液的其他對象。
  
  他們結論表示,在許多高收入國家,對於輕度腸胃炎與最輕微脫水的孩童,使用稀釋的蘋果汁和偏好的液體可能是替代電解質維持溶液的適當方法。
  
  資料來源:http://www.24drs.com/
  
  Native link:Juice, Other Drinks Can Manage Mild Gastroenteritis in Children

Juice, Other Drinks Can Manage Mild Gastroenteritis in Children

By Norra MacReady
Medscape Medical News

Simple remedies such as dilute apple juice may be more effective than an electrolyte solution for treating mild pediatric gastroenteritis, according to findings published online April 30 in JAMA.

In a study of 647 children in Canada, patients with mild gastroenteritis and minimal dehydration experienced fewer treatment failures when offered half-strength apple juice followed by their preferred drinks compared with children given a standard electrolyte maintenance solution, report Stephen B. Freedman, MDCM, and colleagues.

"These results challenge the recommendation to routinely administer electrolyte maintenance solution when diarrhea begins," they write.

Dr Freedman, from the Section of Emergency Medicine and the Section of Gastroenterology, Department of Pediatrics, and Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada, and coauthors enrolled children who presented to the emergency room with symptoms of mild gastroenteritis between October and April of the 2010 to 2015 calendar years. Eligible patients were 6 to 60 months of age, weighed at least 8 kg, and had had at least three episodes of vomiting or diarrhea within the previous 24 hours, with symptoms lasting no more than 96 hours.

The children had a mean age of 28.3 months (standard deviation, 15.9 months) and included 331 boys. The investigators randomly assigned children to receive half-strength apple juice or an apple-flavored electrolyte maintenance solution, with each fluid administered in 5-mL aliquots every 2 to 5 minutes. Children who vomited received ondansetron.

After discharge, children in the study group could receive their preferred fluids such as juice, milk, or sports drinks. Children in the control group continued to receive the electrolyte maintenance solution to replace all fluid losses. Caregivers were instructed to provide the designated fluid in a dose of 2 mL/kg per vomiting episode and 10 mL/kg per episode of diarrhea. They also received diaries and were asked to record details such as symptom frequency and follow-up clinicians' visits.

Of 323 children who received juice and preferred fluids, 54 (16.7%) experienced some form of treatment failure (95% confidence interval [CI], 12.8% - 21.2%) compared with 81 of 324 children treated with the electrolyte solution (25.0%; 95% CI, 20.4% - 30.1%; P < .001). Treatment failure was defined as a composite of intravenous rehydration, hospitalization or an unscheduled physician visit, protracted symptoms, crossover, or loss of 3% of body weight or other symptom of significant dehydration, occurring within 7 days of enrolment.

Secondary outcomes, including intravenous rehydration and hospitalization, were more frequent among children treated with the electrolyte solution. Intravenous rehydration was required by eight children in the apple juice/preferred fluids group (2.5%; 95% CI, 1.1% - 4.8%) and 29 children in the electrolyte solution group (9.0%; 95% CI, 6.1% - 12.6%; P = .001).

The authors suggest that children in the apple juice group were more willing to drink their fluids than the children receiving the electrolyte solution, which was probably less palatable despite the addition of sucralose and apple flavoring. Children older than 24 months derived the greatest benefit from the apple juice/preferred beverage intervention.

For clinicians concerned about the sugar content in apple and other juices, episodes of diarrhea in the current study were "not significantly different between study groups despite the permitted use of high-glucose fluids in the apple juice/preferred fluids group," the authors write. "These results provide pragmatic evidence that in children with minimal dehydration, promoting fluid consumption is more important than glucose load consumed." They observed no significant episodes of hyponatremia.

The authors did caution that because the study was conducted in a high-income nation, the findings cannot be extrapolated to children in middle- and low-income countries, who are at higher risk for complications related to gastroenteritis. It is also not clear whether the results can be generalized to other settings that may use other types of electrolyte maintenance solutions.

"In many high-income countries, the use of dilute apple juice and preferred fluids may be an appropriate alternative to electrolyte maintenance solution use in children with mild gastroenteritis and minimal dehydration," they conclude.

The authors have disclosed no relevant financial relationships.

JAMA. Published online April 30, 2016. Full text

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電解質口服液有助於急性小兒科腸胃炎
2003/1/14 上午 09:39:00

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