Department of Anesthesiology, DUMC 3094, Duke University Medical Center, Durham, North Carolina 27710, USA.
Curr Opin Crit Care. 2009 Dec;15(6):520-4. doi: 10.1097/MCC.0b013e328332f686.
To highlight some of the recent key issues surrounding crystalloid and colloid fluid management of critically ill patients.
Significant developments have been made in the understanding of ionic balance of fluids and their effects on acid-base, the role of hydration and overhydration, alkalinization of fluids in patients at high risk for contrast induced nephropathy, and finally the role of colloids in acute kidney injury.
Despite hydration remaining a key principle in fluid management in many patients, volume overload is of considerable concern. Recent evidence also suggests that balanced electrolyte formulations are preferable to saline-based formulations in a variety of clinical settings. Furthermore, alkalinization of fluids is protective in the setting of contrast-induced nephropathy. Oncotic load appears to be the most important factor in acute kidney injury associated with colloid fluid therapy.
强调一些最近围绕危重症患者晶体液和胶体液管理的关键问题。
在液体的离子平衡及其对酸碱平衡的影响、水化和水过多的作用、高危对比剂肾病患者液体的碱化作用以及胶体在急性肾损伤中的作用等方面取得了重大进展。
尽管在许多患者中，液体管理的关键原则仍然是水化，但容量超负荷是一个相当大的问题。最近的证据还表明，在各种临床情况下，平衡电解质配方优于基于生理盐水的配方。此外，在对比剂肾病的情况下，液体碱化具有保护作用。胶体液治疗相关急性肾损伤中，胶体渗透压似乎是最重要的因素。
