Brugnolli Anna, Canzan Federica, Bevilacqua Anita, Marognolli Oliva, Verlato Giuseppe, Vincenzi Silvia, Ambrosi Elisa
Centre of Higher Education for Health Sciences, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.
School of Nursing, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, Verona, Italy.
Clin Ther. 2017 Feb;39(2):311-321. doi: 10.1016/j.clinthera.2016.12.013. Epub 2017 Jan 23.
Intravenous (IV) fluid therapy is widely used in hospitalized patients. It has been internationally studied in surgical patients, but little attention to date has been dedicated to medical patients within the Italian context. The aims of the present study were to describe the prevalence of fluid therapy and associated factors among Italian patients admitted to medical and surgical units, describe the methods used to manage fluid therapy, and analyze the monitoring of patients by clinical staff.
In this cross-sectional study of 7 hospitals in northern Italy, data on individual and monitoring variables were collected, and their associations with in-hospital fluid therapy were analyzed by using logistic regression analysis. Patients aged ≥18 years who were admitted to medical and surgical units were included. Patients who received at least 500 mL of continuous fluids were included in the fluid therapy group.
In total, 785 (median age, 72 years; women, 52%) patients were included in the study, and 293 (37.3%) received fluid therapy. Maintenance was the most frequent reason for prescribing IV fluid therapy (59%). The mean (SD) volume delivered was 1177 (624) mL/d, and the highest volume was infused for replacement therapy (1660 [931] mL/d). The mean volume infused was 19.55 (13) mL/kg/d. The most commonly used fluid solutions were 0.9% sodium chloride (65.7%) and balanced crystalloid without glucose (32.9%). The proportion of patients assessed for urine output (52.6% vs 36.8%; P < 0.001), serum electrolyte concentrations (74.4% vs 65.0%; P = 0.005), and renal function (70.0% vs 58.7%; P = 0.002) was significantly higher in patients who did receive fluid therapy versus those who did not. In contrast, the use of weight and fluid assessments was not significantly different between the 2 groups (P = 0.216 and 0.256, respectively). Patients admitted for gastrointestinal disorders (odds ratio [OR], 3.5 [95% CI, 1.8-7.05) and for fluid/electrolyte imbalances (OR, 3.35 [95% CI, 1.06-10.52) were more likely to receive fluids. However, the likelihood of receiving fluids was lower for patients admitted to a surgical unit (OR, 0.36 [95% CI, 0.22-0.59]) and with cardiovascular diseases (OR, 0.37 [95% CI, 0.17-0.79).
Only one third of the study patients received fluid therapy. Crystalloid fluids, are the fluids of choice for maintaining plasma volume. During fluid therapy, measurement of the serum electrolyte concentrations, renal function, and urine output was largely used while weight and fluid balance were rarely assessed.
静脉输液疗法在住院患者中广泛应用。该疗法在外科患者中已进行了国际研究，但迄今为止在意大利背景下对内科患者的关注较少。本研究的目的是描述意大利内科和外科病房住院患者的输液疗法患病率及相关因素，描述管理输液疗法的方法，并分析临床工作人员对患者的监测情况。
在这项对意大利北部7家医院的横断面研究中，收集了个体和监测变量的数据，并采用逻辑回归分析其与院内输液疗法的关联。纳入年龄≥18岁、入住内科和外科病房的患者。接受至少500 mL连续液体输注的患者被纳入输液治疗组。
本研究共纳入785例患者（中位年龄72岁；女性占52%），其中293例（37.3%）接受了输液治疗。维持治疗是开具静脉输液治疗最常见的原因（59%）。平均（标准差）输注量为1177（624）mL/天，替代治疗的输注量最高（1660[931]mL/天）。平均输注量为19.55（13）mL/（kg·天）。最常用的液体溶液是0.9%氯化钠（65.7%）和不含葡萄糖的平衡晶体液（32.9%）。接受输液治疗的患者评估尿量（52.6%对36.8%；P<0.001）、血清电解质浓度（74.4%对65.0%；P = 0.005）和肾功能（70.0%对58.7%；P = 0.002）的比例显著高于未接受输液治疗的患者。相比之下，两组在体重和液体评估的使用上无显著差异（P分别为0.216和0.256）。因胃肠道疾病入院的患者（比值比[OR]，3.5[95%CI，1.8 - 7.05]）和因液体/电解质失衡入院的患者（OR，3.35[95%CI，1.06 - 10.52]）更有可能接受输液。然而，入住外科病房的患者（OR，0.36[95%CI，0.22 - 0.59]）和患有心血管疾病的患者（OR，0.37[95%CI，0.17 - 0.79]）接受输液的可能性较低。
本研究中只有三分之一的患者接受了输液治疗。晶体液是维持血浆容量的首选液体。在输液治疗期间，血清电解质浓度、肾功能和尿量的测量被大量使用，而体重和液体平衡很少被评估。
