儿童糖尿病酮症酸中毒的液体选择：一项系统综述与荟萃分析。
完整摘要 · 中文译文
未标记：早期液体复苏对儿童糖尿病酮症酸中毒（DKA）至关重要。虽然0.9%生理盐水是标准治疗，但其高氯含量可能导致高氯性酸中毒。平衡电解质溶液（BES）已被提出作为替代方案以加速代谢恢复，这为开展更新的儿童特异性分析提供了依据。本研究旨在评估BES与0.9%生理盐水相比在儿童DKA中的疗效和安全性。按照Cochrane指南进行了系统综述和荟萃分析，检索PubMed、Embase和Cochrane数据库，纳入比较BES与0.9%生理盐水在儿童DKA中应用的随机对照试验（RCT）和观察性研究。使用随机效应模型进行汇总分析，报告95%CI。共纳入8项研究，包含47,840名参与者。在RCT中，DKA缓解时间（n = 292；MD 2.27 h；95% CI - 0.58至5.11；I2 = 4.4%）或住院时间（n = 225；MD 0.11天；95% CI - 0.75至0.97；I2 = 45.1%）均无显著差异。儿科重症监护病房住院时间（n = 242；MD - 1.18 h）也无显著差异。脑水肿风险（n = 176；RR 1.82；95% CI 0.06至58.80）和急性肾损伤风险（n = 243；RR 1.39；95% CI 0.67至2.87）在组间无差异。 结论：在本研究中，BES与0.9%生理盐水相比在儿童DKA中的临床结局无显著差异。然而，需要更多高质量研究以加强证据基础。当前证据不足以证明其优越性。 、任一液体策略的劣效性或比较安全性。 试验注册：本系统综述已在PROSPERO注册（CRD420261320121）。 已知内容：• 早期液体复苏对儿童糖尿病酮症酸中毒（DKA）至关重要，0.9%盐水是传统的标准治疗。• 0.9%盐水中的高氯含量可能导致高氯性酸中毒，从而引起人们对平衡电解质溶液（BES）作为替代方案的关注。 新发现：• 这项纳入儿科患者的荟萃分析发现，BES与0.9%盐水在DKA缓解时间、住院/儿科重症监护室停留时间或脑水肿等并发症方面无显著差异。• 未来需要高质量随机对照试验（RCT）来完善DKA的儿科液体管理方案并探究潜在的生化获益。
完整摘要 · 英文原文
UNLABELLED: Early fluid resuscitation is critical in pediatric diabetic ketoacidosis (DKA). While 0.9% saline is the standard of care, its high chloride content may cause hyperchloremic acidosis. Balanced electrolyte solutions (BES) have been proposed as alternatives to accelerate metabolic recovery, justifying an updated pediatric-specific analysis. This study aims to evaluate the efficacy and safety of BES compared with 0.9% saline in pediatric DKA. A systematic review and meta-analysis was conducted in accordance with Cochrane guidelines, searching PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) and observational studies comparing BES with 0.9% saline in pediatric DKA. Pooled analysis was performed using random-effects models, with 95% CI. Eight studies comprising 47,840 participants were included. Among RCTs, no significant difference was found in time to DKA resolution (n = 292; MD 2.27 h; 95% CI - 0.58 to 5.11; I2 = 4.4%) or hospital length of stay (n = 225; MD 0.11 days; 95% CI - 0.75 to 0.97; I2 = 45.1%). Pediatric Intensive Care Unit length of stay (n = 242; MD - 1.18 h) also did not differ significantly. The risks of cerebral edema (n = 176; RR 1.82; 95% CI 0.06 to 58.80) and acute kidney injury (n = 243; RR 1.39; 95% CI 0.67 to 2.87) did not differ between groups. CONCLUSION: In this study, BES showed no significant difference in clinical outcomes compared with 0.9% saline in pediatric DKA. However, additional high-quality studies are needed to strengthen the evidence base. Current evidence is insufficient to demonstrate superiority, inferiority or comparative safety of either fluid strategy. TRIAL REGISTRATION: This systematic review was registered in PROSPERO (CRD420261320121). WHAT IS KNOWN: • Early fluid resuscitation is critical in pediatric diabetic ketoacidosis (DKA), with 0.9% saline being the traditional standard of care. • High chloride content in 0.9% saline may cause hyperchloremic acidosis, leading to interest in balanced electrolyte solutions (BES) as alternatives. WHAT IS NEW: • This meta-analysis with pediatric patients found no significant difference between BES and 0.9% saline in the time of DKA resolution, hospital/Pediatric Intensive Care Unit stay, or complications like cerebral edema. • Future high-quality randomized controlled trials (RCTs) are needed to refine pediatric fluid management protocols in DKA and investigate potential biochemical benefits.