Snaith Rosie, Peutrell Jane, Ellis David
The Royal Hospital for Sick Children, Women's and Children's Directorate, NHS Greater Glasgow and Clyde, Dalnair Street, Yorkhill, Glasgow, UK.
Paediatr Anaesth. 2008 Oct;18(10):940-6. doi: 10.1111/j.1460-9592.2008.02698.x. Epub 2008 Jul 21.
To audit past practice of intravenous (i.v.) fluid prescribing and electrolyte monitoring, prior to the publication of guidelines by the National Patient Safety Agency (NPSA, Ref. NPSA/2007/22) in March 2007, highlighting areas of discrepancy, in a specialist children's hospital.
We performed a retrospective case note review of 100 appendectomy patients between February 2004 and March 2007, recording; fluid type and volumes given as maintenance therapy, resuscitation boluses and nasogastric replacement; the frequency and timing of plasma electrolyte measurement; the relationship between plasma sodium [Na] concentration and i.v. fluid prescribed; and patient weight recordings.
Ninety-eight acute appendectomies and two interval elective appendectomies. Median age 10 years (interquartile range: 8-11.25). Before surgery, hypotonic maintenance fluid was prescribed for 94% patients. During surgery, maintenance fluid was predominantly isotonic. After surgery, hypotonic maintenance fluid was prescribed for 92% patients. All maintenance fluid volumes were appropriately calculated according to weight using the Holliday and Segar formula (Paediatrics, 19, 1957, 823). Fluid boluses were isotonic on 128/129 occasions and all accurately calculated according to weight. Nasogastric losses were replaced with 0.9% sodium chloride. No patient had daily plasma electrolyte measurements whilst administered i.v. fluid. Twenty-seven patients had recorded hyponatremia ([Na] <135 mmol x l(-1); 21 at presentation, six subsequently after admission). Hypotonic maintenance fluid was continued in 26/27 patients with hyponatremia. No patient had daily weight recorded.
Our practice of i.v. fluid prescribing and electrolyte monitoring in children, prior to the publication of guidelines by the NPSA in March 2007, did not fully meet the recommended standards.
在2007年3月国家患者安全机构（NPSA，参考文献：NPSA/2007/22）发布指南之前，审核一家专业儿童医院过去静脉输液处方及电解质监测的情况，突出差异之处。
我们对2004年2月至2007年3月期间100例阑尾切除术患者的病历进行回顾性分析，记录：作为维持治疗给予的液体类型和量、复苏推注量及鼻胃管补液量；血浆电解质测量的频率和时间；血浆钠[Na]浓度与所开静脉输液之间的关系；以及患者体重记录。
98例急性阑尾切除术和2例择期阑尾切除术。中位年龄10岁（四分位间距：8 - 11.25岁）。手术前，94%的患者开具了低渗维持液。手术期间，维持液主要为等渗液。手术后，92%的患者开具了低渗维持液。所有维持液量均根据体重使用霍利迪和西加尔公式（《儿科学》，19，1957，823）进行了适当计算。129次推注中有128次为等渗液，且均根据体重准确计算。鼻胃管丢失量用0.9%氯化钠补充。在静脉输液期间，没有患者进行每日血浆电解质测量。27例患者记录有低钠血症（[Na]<135 mmol·L⁻¹；21例入院时存在，6例入院后出现）。27例低钠血症患者中有26例继续使用低渗维持液。没有患者记录每日体重。
在2007年3月NPSA发布指南之前，我们在儿童静脉输液处方及电解质监测方面的做法未完全达到推荐标准。
