NEJM:儿童糖尿病酮症酸中毒输液速率有要求吗?

2018-06-14 xing.T MedSci原创

由此可见,糖尿病酮症酸中毒患儿的给药速率和氯化钠含量均不影响神经功能预后。

儿童糖尿病酮症酸中毒可引起轻度至重度的脑损伤。静脉输液是否有助于这些损伤已经争论了几十年。近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员进行了一项13个中心的随机对照试验,分析了给药速率和静脉输液中氯化钠含量对糖尿病酮症酸中毒患儿神经功能的影响。

在2-2因子设计中,儿童被随机分配给四个治疗组(0.9%或0.45%氯化钠含量和快速或缓慢的给药速率)。该研究的主要结局为在糖尿病酮症酸中毒治疗期间精神状态的下降(连续两次格拉斯哥昏迷量表评分<14),范围从3到15,得分较低,表明精神状态较差)。次要结局包括治疗糖尿病酮症酸中毒期间的临床明显脑损伤、糖尿病酮症酸中毒治疗期间的短期记忆以及糖尿病酮症酸中毒恢复2至6个月后的记忆和智商。

1255例儿童共报道了1389次糖尿病酮症酸中毒。48次(3.5%)糖尿病酮症酸中毒发作中格拉斯哥昏迷评分低于14,12次(0.9%)出现临床显著的脑损伤。治疗组间在格拉斯哥昏迷量表评分下降到14以下的百分比、格拉斯哥昏迷量表评分下降幅度或格拉斯哥昏迷量表评分低于14分的持续时间没有显著差异。对于短期记忆测试的结果;或关于治疗糖尿病酮症酸中毒时临床上显著的脑损伤发生率也无明显差异。儿童糖尿病酮症酸中毒恢复后的记忆和IQ评分也没有显著差异。严重的不良事件较为罕见,除了精神状态改变,在所有治疗组发生具有相似的频率。

由此可见,糖尿病酮症酸中毒患儿的给药速率和氯化钠含量均不影响神经功能预后。

原始出处:
 
Nathan Kuppermann,et al.Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis.N Engl J Med 2018. https://www.nejm.org/doi/full/10.1056/NEJMoa1716816
 
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beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Jun 14 09:36:30 CST 2018, time=2018-06-14, status=1, ipAttribution=)]
    2018-06-20 phoebeyan520

    学习了.谢谢分享

    0

  6. 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objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95536, encryptionId=ecbb9553661, topicName=酮症酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=wgsun, createdTime=Fri Jun 15 22:34:00 CST 2018, time=2018-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=324086, encodeId=41cc324086c5, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Thu Jun 14 09:52:32 CST 2018, time=2018-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=324067, encodeId=425632406ed9, content=学习了.长知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Jun 14 09:36:30 CST 2018, time=2018-06-14, status=1, ipAttribution=)]
    2018-06-15 mashirong
  8. 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  9. 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    2018-06-14 wzb521zf

    一起学习学习

    0

  10. 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    2018-06-14 1ddf0692m34(暂无匿称)

    学习了.长知识

    0

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NAT GENET:研究人员发现儿童肿瘤遗传进化轨迹

在今天,个性化肿瘤学的一个主要挑战是在相同肿瘤中的癌细胞中存在不同的驱动突变。这是否反映了不同肿瘤区域的达尔文进化的主要模式不同尚未被探索。

医学知识:口服补液盐,孩子腹泻心不慌

如果家里孩子发生了腹泻呕吐,一般去医院诊治之后医生都会开具口服补液盐(ORS),那这包口服补液盐(ORS)你用对了吗?

儿童含氟牙膏怎么选?----认识牙膏成分,选择儿童牙膏

认识牙膏成分,选择儿童牙膏 此前有一项超过700人的调研显示:33%的人选择通过“刷牙”的方式来进行防龋。我们每天给自己刷牙以及给孩子刷牙的时候都要用到牙膏。牙膏几乎是最“日用”的日用品,是我们生活中的亲密伙伴。