Mater Medical Research Institute and University of Queensland, Mater Health Services, Stanley Street, South Brisbane, Brisbane, Queensland, Australia.
Curr Opin Crit Care. 2013 Aug;19(4):299-307. doi: 10.1097/MCC.0b013e3283632d46.
This review explores the contemporary definition of the term 'balanced crystalloid' and outlines optimal design features and their underlying rationale.
Crystalloid interstitial expansion is unavoidable, but also occurs with colloids when there is endothelial glycocalyx dysfunction. Reduced chloride exposure may lessen kidney dysfunction and injury with a possible mortality benefit. Exact balance from an acid-base perspective is achieved with a crystalloid strong ion difference of 24 mEq/l. This can be done simply by replacing 24 mEq/l of chloride in 0.9% sodium chloride with bicarbonate or organic anion bicarbonate substitutes. Potassium, calcium and magnesium additives are probably unnecessary. Large volumes of mildly hypotonic crystalloids such as lactated Ringer's solution reduce extracellular tonicity in volunteers and increase intracranial pressure in nonbrain-injured experimental animals. A total cation concentration of 154 mmol/l with accompanying anions provides isotonicity. Of the commercial crystalloids, Ringer's acetate solution is close to balanced from both acid-base and tonicity perspectives, and there is little current evidence of acetate toxicity in the context of volume loading, in contrast to renal replacement.
The case for balanced crystalloids is growing but unproven. A large randomized controlled trial of balanced crystalloids versus 0.9% sodium chloride is the next step.
本文探讨了“平衡晶体液”这一术语的当代定义，并概述了最佳设计特点及其基本原理。
晶体液的间质扩张是不可避免的，但当内皮糖萼功能障碍时，胶体也会发生这种情况。减少氯暴露可能会减轻肾功能障碍和损伤，并可能带来生存获益。从酸碱平衡的角度来看，通过晶体液的强离子差达到 24 mEq/l 即可实现精确平衡。这可以通过简单地用碳酸氢盐或有机阴离子碳酸氢盐替代物替代 0.9%氯化钠中的 24 mEq/l 氯化物来实现。添加钾、钙和镁可能是不必要的。大量轻度低张晶体液，如乳酸林格氏液，会降低志愿者的细胞外渗透压，并增加非脑损伤实验动物的颅内压。阳离子总浓度为 154 mmol/l 并伴有阴离子可提供等渗性。在商业晶体液中，醋酸林格氏液从酸碱和渗透压两方面来看都接近平衡，与肾脏替代治疗相比，在容量负荷的情况下，目前几乎没有证据表明醋酸盐会产生毒性。
平衡晶体液的应用越来越广泛，但仍缺乏证据支持。下一步是进行一项关于平衡晶体液与 0.9%氯化钠的大型随机对照试验。
