Division of Nephrology, Kidney C.A.R.E. Program, University of Cincinnati, Cincinnati, OH.
Adv Chronic Kidney Dis. 2017 Jul;24(4):205-212. doi: 10.1053/j.ackd.2017.05.002.
Fluid resuscitation in the acutely ill must take into consideration numerous elements, including the intravenous solution itself, the phase of resuscitation, and the strategies toward volume management which are paramount. With the advancement in the understanding and implementation of aggressive fluid resuscitation has also come a greater awareness of the resultant fluid toxicity, especially in those that suffer acute kidney injury, and the realization that there is continued ambiguity with regard to volume mitigation and removal in the resuscitated patient. As such, the discussion regarding intravenous solutions continues to evolve especially as it pertains to their effect on kidney and metabolic function, electrolytes, and ultimately patient outcome. In the section below, we review the foundations of fluid resuscitation in the critically ill patient and the different solutions available in this context, including their composition, physiologic properties, and safety and efficacy including the available data regarding "renal-safe" options.
在治疗急症患者时，液体复苏必须考虑到许多因素，包括静脉输液本身、复苏阶段以及至关重要的容量管理策略。随着对积极液体复苏的理解和实施的进步，人们也越来越意识到由此产生的液体毒性，特别是在那些患有急性肾损伤的患者中，并且认识到在复苏患者中，关于容量减轻和清除仍然存在模糊性。因此，关于静脉输液的讨论仍在不断发展，特别是涉及它们对肾脏和代谢功能、电解质的影响，以及最终对患者预后的影响。在下面的部分中，我们回顾了危重病患者液体复苏的基础以及在此背景下可用的不同溶液，包括它们的组成、生理特性以及安全性和有效性，包括有关“肾脏安全”选择的可用数据。
