登革熱靜脈輸液治療主要針對嚴重個案. 在謹慎的治療之下, 重症死亡率可降到 1% 以下. 但病患從一般狀況進展到重症. 不容易區分.
輸液原則, 針對重症病患. 給予最少的點滴. 維持正常的生理循環所需(可監測尿量. 維持每小時每公斤 0.5cc 小便)
需注意一些警示徵象. 每 1-4 小時測量病患生命徵象. 每 4-6 小時紀錄尿量.
通常打點滴的時間大約 24-48 小時, 當重症患者病情逐漸改善. 需減少輸液量. 避免過度輸液. 當血漿滲漏出的體液回到血管內. 若是過度輸液可能造成肺水腫. 心衰竭.
WHO版本 DHF guideline
A joint publication of the World Health Organization (WHO) and the Special Programme for Research and Training in Tropical Diseases (TDR) 21 April 2009
| Technical document
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1.1.6 Dengue case classification Dengue has a wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. While most patients recover following a self-limiting non-severe clinical course, a small proportion progress to severe disease, mostly characterized by plasma leakage with or without haemorrhage. Intravenous rehydration is the therapy of choice; this intervention can reduce the case fatality rate to less than 1% of severe cases. The group progressing from non-severe to severe disease is difficult to define, but this is an important concern since appropriate treatment may prevent these patients from developing more severe clinical conditions.
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Children are at a higher risk of severe dengue (39). Intensive care is required for severely ill patients, including intravenous fluids, blood or plasma transfusion and medicines.
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Those who deteriorate will manifest with warning signs. This is called dengue with warning signs (Textbox C). Cases of dengue with warning signs will probably recover with early intravenous rehydration. Some cases will deteriorate to severe dengue (see below).
Respiratory distress from massive pleural effusion and ascites will occur at any time if excessive intravenous fluids have been administered. During the critical and/or recovery phases, excessive fluid therapy is associated with pulmonary oedema or congestive heart failure.
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Give the minimum intravenous fluid volume required to maintain good perfusion and urine output of about 0.5 ml/kg/hr. Intravenous fluids are usually needed for only 24–48 hours. Reduce intravenous fluids gradually when the rate of plasma leakage decreases towards the end of the critical phase. This is indicated by urine output and/or oral fluid intake that is/are adequate, or haematocrit decreasing below the baseline value in a stable patient.
• Patients with warning signs should be monitored by health care providers until the period of risk is over. A detailed fluid balance should be maintained. Parameters that should be monitored include vital signs and peripheral perfusion (1–4 hourly until the patient is out of the critical phase), urine output (4–6 hourly), haematocrit (before and after fluid replacement, then 6–12 hourly), blood glucose, and other organ functions (such as renal profile, liver profile, coagulation profile, as indicated).
台灣疾病管制署-登革熱臨床症狀‧診斷與治療(第六版) 2015年5月出版
