Title: Hyaluronidase Facilitated Subcutaneous Rehydration (submitted by Marina Kloyzner, MD)
题目：透明质酸酶促进皮下补液（由Marina Kloyzner博士提交）
Author 作者: Mimi Lu
翻译：江利冰 校对：肖锋

Dehydration is a common pediatric ED presentation.  Oral rehydration (although first choice) is often not possible secondary to patient cooperation and/ or persistent vomiting.  Intravenous (IV) hydration is often difficult, requiring multiple attempts especially in the young dehydrated infant.
脱水是儿科急诊常见的症状。口服补液（尽管是第一选择）往往是困难的因为患者的不配合以及持续的呕吐。静脉内补液也是困难的，需要多次尝试，尤其是在年龄比较小的婴儿。

Hyaluronan is a mucopolysaccharude present in connective tissue that prevents the spread of substances through the subcutneous space.  Hyaluronidase is a human DNA-derived enzyme that breaks down hyaluronan and temporarily increases its permeability, thereby allowing fluid to be absorbed with the capillary and lymphatic systems.
透明质酸是一种酸性粘多糖，存在于结缔组织中，防止物质在皮下空间扩散。透明质酸酶是一种DNA酶，分解透明质酸，暂时增加其渗透性，因此容许液体被毛细血管以及淋巴系统再吸收。

In one study, patients age 1 month to 10 years were randomized to recieve 20 mL/kg bolus NS via subcutaneous (SC) or IV route over one hour, then as needed.  The mean volume infused in the ED was 334.3 mL (SC) vs 299.6 mL (IV).  Succesful line placement occured in all 73 SC patients and only 59/75 IV patients.  There was a higher proportion of satisfaction for clinicians and parents for ease of use and satisfaction, respectively.
 在一项研究中，年龄在1个月至10岁的儿童被随机分配接受皮下或者静脉20mL/kg的生理盐水，然后根据情况补液。急诊科平均输液量为334.3 mL (SC) vs 299.6 mL (IV)。在皮下补液组，73例患者均成功置管，在静脉补液组75例患者中59例成功置管。更高比例的医生和双亲对皮下补液感到满意和使用方便。

Bottom line: Consider subcutaneous hyaluronidase faciliated rehydration in mild to moderately dehydrated children, especially with difficult IV access.
 要点：皮下透明质酸酶可以促进轻中度脱水儿童进行皮下补液，尤其是困难静脉置管的患者。

References 参考文献
Spandorfer PR, et al. A Randomized Clinical Trial of Recombinant Human Hyaluronidase-Fcilitated Subcutaneous Versus Intravenous Rehydration in Mild to Moderately Dehydrated Children in the Emergency Department[J]. Clinical Therapeutics, 2012; 34(11): 2232-2245.
www.ncbi.nlm.nih.gov/pubmed/23062548