小儿急性轮状病毒肠炎水电解质及酸碱平衡紊乱的临床分析  

Clinical Analysis on Water-Electrolyte and Disturbance of Acid-Base Balance in Children with Acute Rotavirus Enteritis

作　　者：朱卫东[1] 朱翠平[1] 

机构地区：[1]广州市儿童医院急诊科,广州510120

出　　处：《热带医学杂志》2009年第2期190-192,共3页Journal of Tropical Medicine

摘　　要：目的探讨小儿急性轮状病毒肠炎的脱水程度、电解质、渗透压和阴离子间隙(AG)的变化情况以及相互间的关系。方法150例患儿均在治疗前作血气分析,并作血清Na+、K+、Cl-、HCO3-和渗透压的测定,AG按Na+-(Cl-+HCO3-)计算,所有患儿均采用ELISA方法检测大便轮状病毒抗原。结果脱水程度以轻中度为主,占89.3%,代谢性酸中毒、高氯血症和低钾血症分别为76.7%、14.6%和28%。酸中毒随脱水而加重(χ2=34.2,P<0.01)。渗透压以等渗为多(69.3%),低渗次之(25.3)%,高渗仅5.4%,渗透压与血Na+浓度呈正相关(χ2=297,P<0.01)。正常AG型代谢性酸中毒占60.8%,AG与血Na+呈正相关,AG水平随脱水程度的加重而升高(χ2=9.828,P<0.01)。结论轮状病毒肠炎易导致轻至中度脱水、低钾血症和代谢性酸中毒;以等渗性脱水和正常AG型代酸为主。及时纠正脱水能避免代谢性酸中毒加重以及有效减少高AG型代酸的发生。Objective To study the changing state of dehydration, electrolyte, osmotic pressure and anion gap （AG） as well as the relation among them in children with acute rotavirus enteritis. Method Before treatment, blood gas analysis,serum Na^＋, K^＋, CI^-, HCO3^- and osmotic pressure were detected in 150 patients. AG was calculated according to Na^＋-（CI^-＋HCO3^-）. Rotavirus antigens in faeces of all children were determined by ELISA method. Result Mild and moderate degree dehydration, metabolic acidosis, hyperchloremia and hypokalemia were 89.3%, 76.7%, 14.6% and 28%, respectively. Dehydration became severe with acidosis （χ^2=34.2,P〈0.01）. 69.3% of the patients were with isosmotic pressure, 25.3% with hypoosmotic pressure and only 5.4% with hypertonic pressure. Osmotic pressure and serum Na^＋ showed positive correlation（χ^2=297, P〈0.01）. 60.8% of the patients had metabolic acidosis with normal AG. AG and serum Na＋ showed positive correlation, and the level of AG increase with dehydration （χ^2=9.828, P〈0.01 ）. Conclusion Rotavirus enteritis usually induces mild and moderate degree dehydration, metabolic acidosis and hypokalemia. Isosmotic pressure dehydration and metabolic acidosis with normal AG are primary clinical manifestation. Correcting dehydration in time would avoid the aggravation of metabolic acidosis and diminish the incidence of high AG.

关 键 词：轮状病毒肠炎 脱水 电解质 阴离子间隙 

分 类 号：R512.5[医药卫生—内科学]