Inserm, Unité de Recherche en Épidémiologie Systèmes d'Information et Modélisation (U707), Paris F-75012, France.
Crit Care. 2010;14(5):325. doi: 10.1186/cc9230. Epub 2010 Oct 21.
The present review of fluid therapy studies using balanced solutions versus isotonic saline fluids (both crystalloids and colloids) aims to address recent controversy in this topic. The change to the acid-base equilibrium based on fluid selection is described. Key terms such as dilutional-hyperchloraemic acidosis (correctly used instead of dilutional acidosis or hyperchloraemic metabolic acidosis to account for both the Henderson-Hasselbalch and Stewart equations), isotonic saline and balanced solutions are defined. The review concludes that dilutional-hyperchloraemic acidosis is a side effect, mainly observed after the administration of large volumes of isotonic saline as a crystalloid. Its effect is moderate and relatively transient, and is minimised by limiting crystalloid administration through the use of colloids (in any carrier). Convincing evidence for clinically relevant adverse effects of dilutional-hyperchloraemic acidosis on renal function, coagulation, blood loss, the need for transfusion, gastrointestinal function or mortality cannot be found. In view of the long-term use of isotonic saline either as a crystalloid or as a colloid carrier, the paucity of data documenting detrimental effects of dilutional-hyperchloraemic acidosis and the limited published information on the effects of balanced solutions on outcome, we cannot currently recommend changing fluid therapy to the use of a balanced colloid preparation.
本综述旨在探讨目前有关平衡溶液与等渗盐水液（晶体液和胶体液）在液体治疗中应用的争议。文中描述了基于液体选择对酸碱平衡的影响。还对关键术语如稀释性高氯性酸中毒（正确地使用稀释性酸中毒或高氯性代谢性酸中毒来代替，以同时考虑 Henderson-Hasselbalch 和 Stewart 方程）、等渗盐水和平衡溶液进行了定义。综述得出结论，稀释性高氯性酸中毒是一种副作用，主要发生在大量输注等渗盐水作为晶体液后。其影响是中度和相对短暂的，通过限制晶体液的输注（使用任何载体的胶体液）可以最小化其影响。没有发现稀释性高氯性酸中毒对肾功能、凝血、失血、输血需求、胃肠道功能或死亡率有临床相关不良影响的令人信服的证据。鉴于等渗盐水的长期应用，无论是作为晶体液还是胶体液的载体，关于稀释性高氯性酸中毒有害影响的数据很少，关于平衡溶液对结果影响的信息也有限，因此我们目前不能推荐将液体治疗改为使用平衡胶体液。
