腹泻及其液体疗法-培训课件.pptVIP

* * * Previously it was common to rest the gastrointestinal tract for 24-48 hours whilst correcting dehydration and allowing functional recovery of the intestinal mucosa. Clinical studies have shown that an early return to feeding has both clinical and nutritional benefits A meta-analysis of RCTs showed that early refeeding in gastroenteritis reduces the duration of diarrhoea (0.43 days; 95% CI, - 0.74 to 0.12). * Two subsequent RCTs showed that early refeeding improves weight gain without increasing either vomiting or diarrhoea duration. ** *Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Pediatrics 1996; 97: 424-435. **Brown KH, Gastanaduy AS, Saavedra JM, et al. Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhea in children. J Pediatr 1988; 112: 191-200. Sandhu BK, Isolauri E, Walker-Smith JA, et al. A multicentre study on behalf of the European Society of Paediatric Gastroenterology and Nutrition Working Group on Acute Diarrhoea. Early feeding in childhood gastroenteritis. J Pediatr Gastroenterol. Nutr 1997; 24: 522-527. * 不同程度代谢性酸中毒的临床特点 轻 度 中 度 重 度 呼吸改变 不明显 深大 深大、叹气样 唇樱红色 轻微 樱红色 紫红（绀） 呼吸酮味 无 轻微 明显 面 色 苍白 苍灰 灰色或发绀 休 克 无 无、轻 重 神志改变 无 无、轻 重 恶心呕吐 无 无、有 明显 HC O3- mmol/L 13-18 9-13 9 CO2 CP Vol % 30-40 20-30 20 代谢性酸中毒 处理（补充碱剂） ①公式计算碱剂需要量： mmol=(22-测得HCO3根)mmol/L×0.6×体重(