Steurer M A, Berger T M
Neonatologische und pädiatrische Intensivpflegestation, Kinderspital Luzern, Lucerne, Switzerland.
Anaesthesist. 2011 Jan;60(1):10-22. doi: 10.1007/s00101-010-1824-5.
Intravenous administration of fluids, electrolytes and glucose are the most common interventions in hospitalized pediatric patients. Parenteral fluid administration can be life-saving, however, if used incorrectly it also carries substantial risks. Perioperatively, adequate hydration, prevention of electrolyte imbalances and maintenance of normoglycemia are the main goals of parenteral fluid therapy. Conceptionally, the distinction between maintenance requirements, deficits and ongoing loss is helpful. Although the pathophysiological basis for parenteral fluid therapy was clarified in the first half of the 20th century, some aspects still remain controversial. In newborn infants, rational parenteral fluid therapy must take into account large insensible fluid losses, adaptive changes of renal function in the first days of life and the fact that neonates do not tolerate prolonged periods of fasting. In older infants the occurrence of iatrogenic hyponatremia with the use of hypotonic solutions has led to a critical reappraisal of the validity of the Holliday-Segar method for calculating maintenance fluid requirements in the postoperative period. Pragmatically, only isotonic solutions should be used in clinical situations which are known to be associated with increases in antidiuretic hormone (ADH) secretion. In this context, it is important to realize that in contrast to lactated Ringer's solution, the use of normal saline can lead to hyperchloremic acidosis in a dose-dependent fashion. Although there is no convincing evidence that colloids are better than crystalloids, there are clinical situations where the use of the more expensive colloids seems justified. It may be reasonable to choose a solution for fluid replacement which has a composition comparable to the composition of the fluid which must be replaced. Although hypertonic saline can reduce an elevated intracranial pressure, this therapy cannot be recommended as a routine procedure because there is currently no evidence that this intervention improves long-term outcome in pediatric patients with traumatic brain injury.
静脉输注液体、电解质和葡萄糖是住院儿科患者最常见的干预措施。肠外补液可挽救生命，但如果使用不当也会带来重大风险。围手术期，充足的水合作用、预防电解质失衡和维持血糖正常是肠外补液治疗的主要目标。从概念上讲，区分维持需求、缺失量和持续丢失量是有帮助的。尽管肠外补液治疗的病理生理基础在20世纪上半叶已得到阐明，但某些方面仍存在争议。对于新生儿，合理的肠外补液治疗必须考虑到大量的不显性失液、出生后几天肾功能的适应性变化以及新生儿不耐受长时间禁食这一事实。在较大婴儿中，使用低渗溶液导致医源性低钠血症的发生，促使人们对霍利迪 - 西加尔方法在术后计算维持液需求量的有效性进行了批判性重新评估。实际上，在已知与抗利尿激素（ADH）分泌增加相关的临床情况下，应仅使用等渗溶液。在此背景下，必须认识到与乳酸林格氏液不同，使用生理盐水会以剂量依赖的方式导致高氯性酸中毒。尽管没有令人信服的证据表明胶体溶液优于晶体溶液，但在某些临床情况下，使用更昂贵的胶体溶液似乎是合理的。选择一种成分与必须补充的液体成分相当的液体替代溶液可能是合理的。尽管高渗盐水可降低升高的颅内压，但目前没有证据表明这种干预可改善创伤性脑损伤儿科患者的长期预后，因此不建议将此疗法作为常规操作。
