Choong K, Kho M E, Menon K, Bohn D
Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada.
Arch Dis Child. 2006 Oct;91(10):828-35. doi: 10.1136/adc.2005.088690. Epub 2006 Jun 5.
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.
To systematically review the evidence from studies evaluating the safety of administering hypotonic versus isotonic i.v. maintenance fluids in hospitalised children.
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.
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.
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.
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。
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。
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。
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。
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。