Suppr超能文献

住院儿童使用低渗盐水与等渗盐水的比较:一项系统评价

Hypotonic versus isotonic saline in hospitalised children: a systematic review.

作者信息

Choong K, Kho M E, Menon K, Bohn D

机构信息

Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada.

出版信息

Arch Dis Child. 2006 Oct;91(10):828-35. doi: 10.1136/adc.2005.088690. Epub 2006 Jun 5.

Abstract

BACKGROUND

The traditional recommendations which suggest that hypotonic intravenous (i.v.) maintenance fluids are the solutions of choice in paediatric patients have not been rigorously tested in clinical trials, and may not be appropriate for all children.

AIMS

To systematically review the evidence from studies evaluating the safety of administering hypotonic versus isotonic i.v. maintenance fluids in hospitalised children.

DATA SOURCES

Medline (1966-2006), Embase (1980-2006), the Cochrane Library, abstract proceedings, personal files, and reference lists. Studies that compared hypotonic to isotonic maintenance solutions in children were selected. Case reports and studies in neonates or patients with a pre-existing history of hyponatraemia were excluded.

RESULTS

Six studies met the selection criteria. A meta-analysis combining these studies showed that hypotonic solutions significantly increased the risk of developing acute hyponatraemia (OR 17.22; 95% CI 8.67 to 34.2), and resulted in greater patient morbidity.

CONCLUSIONS

The current practice of prescribing i.v. maintenance fluids in children is based on limited clinical experimental evidence from poorly and differently designed studies, where bias could possibly raise doubt about the results. They do not provide evidence for optimal fluid and electrolyte homoeostasis in hospitalised children. This systematic review indicates potential harm with hypotonic solutions in children, which can be anticipated and avoided with isotonic solutions. No single fluid rate or composition is ideal for all children. However, isotonic or near-isotonic solutions may be more physiological, and therefore a safer choice in the acute phase of illness and perioperative period.

摘要

背景

传统建议认为低渗静脉维持液是儿科患者的首选溶液,但尚未在临床试验中得到严格验证,可能并不适用于所有儿童。

目的

系统评价评估住院儿童使用低渗与等渗静脉维持液安全性的研究证据。

数据来源

医学索引数据库(1966 - 2006年)、荷兰医学文摘数据库(1980 - 2006年)、考克兰图书馆、摘要汇编、个人文件及参考文献列表。选取比较儿童低渗与等渗维持液的研究。排除病例报告以及针对新生儿或有低钠血症既往史患者的研究。

结果

六项研究符合入选标准。对这些研究进行的荟萃分析表明,低渗溶液显著增加了发生急性低钠血症的风险(比值比17.22;95%可信区间8.67至34.2),并导致更高的患者发病率。

结论

目前儿童静脉维持液的处方做法基于设计不佳且各异的研究中有限的临床实验证据,其中的偏倚可能会使结果受到质疑。这些研究并未为住院儿童最佳的液体和电解质平衡提供证据。本系统评价表明低渗溶液对儿童有潜在危害,而等渗溶液可预期并避免这种危害。没有单一的液体输注速率或成分对所有儿童都是理想的。然而,等渗或接近等渗的溶液可能更符合生理需求,因此在疾病急性期和围手术期是更安全的选择。

相似文献

1
Hypotonic versus isotonic saline in hospitalised children: a systematic review.
Arch Dis Child. 2006 Oct;91(10):828-35. doi: 10.1136/adc.2005.088690. Epub 2006 Jun 5.
2
Water for wound cleansing.
Cochrane Database Syst Rev. 2022 Sep 14;9(9):CD003861. doi: 10.1002/14651858.CD003861.pub4.
3
Interventions for chronic non-hypovolaemic hypotonic hyponatraemia.
Cochrane Database Syst Rev. 2018 Jun 28;6(6):CD010965. doi: 10.1002/14651858.CD010965.pub2.
4
Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children.
Cochrane Database Syst Rev. 2014 Dec 18;2014(12):CD009457. doi: 10.1002/14651858.CD009457.pub2.
5
Saline irrigation for allergic rhinitis.
Cochrane Database Syst Rev. 2018 Jun 22;6(6):CD012597. doi: 10.1002/14651858.CD012597.pub2.
6
Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients.
Cochrane Database Syst Rev. 2021 Nov 26;11(11):CD013307. doi: 10.1002/14651858.CD013307.pub3.
8
Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children.
Cochrane Database Syst Rev. 2005 Jan 25(1):CD001801. doi: 10.1002/14651858.CD001801.pub2.
9
Vaccines for preventing influenza in healthy children.
Cochrane Database Syst Rev. 2018 Feb 1;2(2):CD004879. doi: 10.1002/14651858.CD004879.pub5.
10
Positioning for acute respiratory distress in hospitalised infants and children.
Cochrane Database Syst Rev. 2022 Jun 6;6(6):CD003645. doi: 10.1002/14651858.CD003645.pub4.

引用本文的文献

1
Maintenance intravenous fluid therapy in infants with sepsis and hyponatremia: a clinical trial.
BMC Pediatr. 2024 Aug 2;24(1):497. doi: 10.1186/s12887-024-04901-0.
2
A balancing act: drifting away from the reflexive use of "ab"normal saline.
Pediatr Nephrol. 2024 Aug;39(8):2325-2335. doi: 10.1007/s00467-023-06271-8. Epub 2024 Jan 18.
6
Hypernatremia in Newborns: A Practical Approach to Management.
Biomed Hub. 2022 May 19;7(2):55-69. doi: 10.1159/000524637. eCollection 2022 May-Aug.

本文引用的文献

2
Fluid therapy; relation to tissue composition and the expenditure of water and electrolyte.
J Am Med Assoc. 1950 Jun 3;143(5):432-9. doi: 10.1001/jama.1950.82910400006007.
4
Hypotonic vs isotonic saline solutions for intravenous fluid management of acute infections.
Cochrane Database Syst Rev. 2004;2003(2):CD004169. doi: 10.1002/14651858.CD004169.pub2.
5
Rubbing salt in the wound.
Arch Dis Child. 2004 May;89(5):414-8. doi: 10.1136/adc.2003.045047.
6
Pouring salt on troubled waters.
Arch Dis Child. 2004 May;89(5):411-4. doi: 10.1136/adc.2003.045302.
7
Intravenous fluids for seriously ill children: time to reconsider.
Lancet. 2003 Oct 18;362(9392):1320-3. doi: 10.1016/S0140-6736(03)14577-1.
9
Quantitative requirements of the infant and child for water and electrolyte under varying conditions.
Am J Clin Pathol. 1953 Nov;23(11):1133-41. doi: 10.1093/ajcp/23.11.1133.
10
How to select optimal maintenance intravenous fluid therapy.
QJM. 2003 Aug;96(8):601-10. doi: 10.1093/qjmed/hcg101.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验