Severs David, Hoorn Ewout J, Rookmaaker Maarten B
Department of Internal Medicine - Nephrology & Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
Nephrol Dial Transplant. 2015 Feb;30(2):178-87. doi: 10.1093/ndt/gfu005. Epub 2014 Jan 23.
Fluid management has been a vital part of routine clinical care for more than 180 years. The increasing number of available fluids has generated controversy about the optimal choice of resuscitation fluid. In this review, we provide a critical overview of the different fluids available, their composition, the relevant physiology as well as the published evidence on clinical outcomes to guide their use. Commonly used infusion fluids include semisynthetic colloids and crystalloids; the latter comprises both normal saline (NaCl 0.9%) and the more chloride-restricted 'balanced' crystalloids. Despite their significantly greater intravascular persistence, semisynthetic colloids have an importantly adverse safety profile and are associated with greater incidence of renal failure and increased mortality; their use should be restricted. To date, evidence for clinical benefits associated with albumin solutions is generally lacking; its merits in specific clinical situations are the subject of further investigation. Infusion of normal saline, with its supraphysiological chloride content, is associated with higher serum chloride concentrations and metabolic acidosis, as well as renal vasoconstriction in animal and human models. Infusion of 'balanced' crystalloids is not linked to such changes. Although data on clinical outcomes associated with crystalloid infusion are heterogeneous, advantages of balanced salt solutions might include a lower need of blood products, and lower incidence of renal replacement therapy, hyperkalaemia and postoperative infections. Taken together, a critical appraisal of the data suggests that balanced salt solutions deserve consideration as infusates of first choice.
在超过180年的时间里，液体管理一直是常规临床护理的重要组成部分。可用液体种类的不断增加引发了关于复苏液体最佳选择的争议。在本综述中，我们对现有不同液体、其成分、相关生理学以及已发表的关于临床结局的证据进行了批判性概述，以指导其使用。常用的输注液包括半合成胶体和晶体液；后者包括生理盐水（0.9%氯化钠）和氯化物限制更多的“平衡”晶体液。尽管半合成胶体在血管内的存留时间明显更长，但其具有重要的不良安全性，与肾衰竭发生率更高和死亡率增加相关；应限制其使用。迄今为止，通常缺乏与白蛋白溶液相关的临床益处的证据；其在特定临床情况下的优点有待进一步研究。输注含超生理氯化物含量的生理盐水会导致血清氯化物浓度升高和代谢性酸中毒，以及在动物和人体模型中引起肾血管收缩。输注“平衡”晶体液则不会出现此类变化。尽管与晶体液输注相关的临床结局数据存在异质性，但平衡盐溶液的优点可能包括对血液制品的需求较低，以及肾脏替代治疗、高钾血症和术后感染的发生率较低。综合来看，对数据的批判性评估表明，平衡盐溶液值得作为首选输注液加以考虑。
