de Saint-Aurin R Gallet, Kloeckner M, Annane D
Service de Réanimation médicale, Hôpital Raymond Poincaré, Faculté de Médecine Paris Ile de France Ouest, Garches.
Acta Clin Belg. 2007;62 Suppl 2:412-6. doi: 10.1179/acb.2007.093.
The choice of crystalloid or colloid for fluid resuscitation has been debated for the last few years. Although colloids seems to be more interesting when taking into account their physiological properties, their effect on mortality is not better than crystalloids if they are used in an adequate amount. Moreover, colloids' side effects are far more important than those of crystalloids. Several randomised studies pointed out the renal effects of colloids including acute renal injury with an increased need of renal replacement therapy. An unacceptably high rate of renal side effects has resulted in premature termination of some clinical trials. In addition, homeostatic and anaphylactoid effects of colloids on coagulation and on anaphylaxis may increase the risk of death associated with their use. Finally, colloids are much more expensive than crystalloids. For all these reasons, we conclude that crystalloids should be preferred to colloids for fluid resuscitation.
在过去几年中，对于液体复苏时选择晶体液还是胶体液一直存在争议。尽管从胶体液的生理特性来看似乎更具优势，但如果使用足够量的晶体液，其对死亡率的影响并不比胶体液差。此外，胶体液的副作用远比晶体液严重。多项随机研究指出了胶体液对肾脏的影响，包括急性肾损伤以及肾脏替代治疗需求增加。胶体液不可接受的高肾脏副作用发生率导致了一些临床试验提前终止。此外，胶体液对凝血和过敏反应的内稳态及类过敏反应可能会增加与其使用相关的死亡风险。最后，胶体液比晶体液昂贵得多。基于所有这些原因，我们得出结论，在液体复苏时应优先选择晶体液而非胶体液。
