Liamis George, Filippatos Theodosios D, Elisaf Moses S
Department of Internal Medicine, School of Medicine, University of Ioannina , Ioannina , Greece.
Postgrad Med. 2015 May;127(4):405-12. doi: 10.1080/00325481.2015.1029421. Epub 2015 Mar 26.
Many situations in clinical practice involving patients with hypovolemia or acutely ill patients usually require the administration of intravenous fluids. Current evidence shows that the use of crystalloids should be considered, since most colloids and human albumin are usually associated with increased adverse effects and high cost, respectively. Among crystalloids, the use of normal saline is implicated with the development of hyperchloremic metabolic acidosis and renal vasoconstriction. These observations have led many authors to propose balanced solutions, mainly Lactated Ringer's, as the infusate of choice. However, although the restoration of volume status is the primary target in hypovolemic state, the correction of any associated acid-base or electrolyte disorders that frequently coexist is also of vital importance. This review presents specific situations that are common in daily clinical practice and require targeted infusate therapy in patients with reduced volume status. Furthermore, the review presents an algorithm aiming to help clinicians to make the best choice between normal or hypotonic saline and lactated Ringer's infusates. Lactated Ringer's infusate should not be given in patients with severe metabolic alkalosis, lactic acidosis with decreased lactate clearance, or severe hyperkalemia, and in patients with traumatic brain injury or at risk of increased intracranial pressure. The optimal choice of infusate should be guided by the cause of hypovolemia, the cardiovascular state of the patient, the renal function, as well as the serum osmolality and the coexisting acid-base and electrolyte disorders. Clinicians should be aware of any coexisting disorders in patients with hypovolemia and guide their choice of infusate treatment based on the overall picture of their patients.
临床实践中，许多涉及低血容量患者或急症患者的情况通常需要静脉输注液体。目前的证据表明，应考虑使用晶体液，因为大多数胶体液和人白蛋白通常分别与不良反应增加和成本高昂有关。在晶体液中，使用生理盐水与高氯性代谢性酸中毒和肾血管收缩的发生有关。这些观察结果促使许多作者提出平衡液，主要是乳酸林格液，作为首选的输注液。然而，尽管恢复容量状态是低血容量状态下的主要目标，但纠正经常并存的任何相关酸碱或电解质紊乱也至关重要。本综述介绍了日常临床实践中常见的特定情况，这些情况需要对低血容量状态的患者进行有针对性的输注液治疗。此外，该综述还提出了一种算法，旨在帮助临床医生在生理盐水或低渗盐水与乳酸林格液之间做出最佳选择。严重代谢性碱中毒、乳酸清除率降低的乳酸性酸中毒或严重高钾血症患者，以及创伤性脑损伤患者或有颅内压升高风险的患者不应使用乳酸林格液。输注液的最佳选择应根据低血容量的原因、患者的心血管状态、肾功能以及血清渗透压和并存的酸碱及电解质紊乱来指导。临床医生应了解低血容量患者中任何并存的疾病，并根据患者的整体情况指导其输注液治疗的选择。
