Blumberg Neil, Cholette Jill M, Pietropaoli Anthony P, Phipps Richard, Spinelli Sherry L, Eaton Michael P, Noronha Suzie A, Seghatchian Jerard, Heal Joanna M, Refaai Majed A
Department of Pathology and Laboratory Medicine (Transfusion Medicine), University of Rochester Medical Center, Rochester, NY, USA.
Department of Pediatrics (Critical Care and Cardiology), University of Rochester Medical Center, Rochester, NY (USA), USA.
Transfus Apher Sci. 2018 Feb;57(1):127-131. doi: 10.1016/j.transci.2018.02.021. Epub 2018 Feb 21.
Crystalloid infusion is widely employed in patient care for volume replacement and resuscitation. In the United States the crystalloid of choice is often normal saline. Surgeons and anesthesiologists have long preferred buffered solutions such as Ringer's Lactate and Plasma-Lyte A. Normal saline is the solution most widely employed in medical and pediatric care, as well as in hematology and transfusion medicine. However, there is growing concern that normal saline is more toxic than balanced, buffered crystalloids such as Plasma-Lyte and Lactated Ringer's. Normal saline is the only solution recommended for red cell washing, administration and salvage in the USA, but Plasma-Lyte A is also FDA approved for these purposes. Lactated Ringer's has been traditionally avoided in these applications due to concerns over clotting, but existing research suggests this is not likely a problem. In animal models and clinical studies in various settings, normal saline can cause metabolic acidosis, vascular and renal function changes, as well as abdominal pain in comparison with balanced crystalloids. The one extant randomized trial suggests that in very small volumes (2 l or less) normal saline is not more toxic than other crystalloids. Recent evidence suggests that normal saline causes substantially more in vitro hemolysis than Plasma-Lyte A and similar solutions during short term storage (24 hours) after washing or intraoperative salvage. There are now abundant data to raise concerns as to whether normal saline is the safest replacement solution in infusion therapy, red cell washing and salvage, apheresis and similar uses. In the USA, Plasma-Lyte A is also FDA approved for use with blood components and is likely a safer solution for these purposes. Its only disadvantage is a higher cost. Additional studies of the safety of normal saline for virtually all current clinical uses are needed. It seems likely that normal saline will eventually be abandoned in favor of safer, more physiologic crystalloid solutions in the coming years.
晶体液输注广泛应用于患者护理中，用于补充血容量和进行复苏。在美国，常用的晶体液通常是生理盐水。长期以来，外科医生和麻醉医生更倾向于使用缓冲溶液，如乳酸林格氏液和聚明胶肽A。生理盐水是医疗、儿科护理以及血液学和输血医学中使用最广泛的溶液。然而，人们越来越担心生理盐水比平衡的、缓冲的晶体液（如聚明胶肽和乳酸林格氏液）毒性更大。在美国，生理盐水是唯一推荐用于红细胞洗涤、输注和回收的溶液，但聚明胶肽A也已获得美国食品药品监督管理局（FDA）批准用于这些用途。由于担心凝血问题，传统上乳酸林格氏液在这些应用中被避免使用，但现有研究表明这可能不是问题。在各种环境下的动物模型和临床研究中，与平衡晶体液相比，生理盐水会导致代谢性酸中毒、血管和肾功能变化以及腹痛。一项现存的随机试验表明，在非常少量（2升或更少）的情况下，生理盐水的毒性并不比其他晶体液更大。最近的证据表明，在洗涤或术中回收后的短期储存（24小时）期间，生理盐水比聚明胶肽A和类似溶液在体外引起的溶血要多得多。现在有大量数据引发了人们对生理盐水在输液治疗、红细胞洗涤和回收、血液成分单采及类似用途中是否是最安全的替代溶液的担忧。在美国，聚明胶肽A也已获得FDA批准用于与血液成分一起使用，并且可能是用于这些目的的更安全的溶液。其唯一的缺点是成本较高。需要对生理盐水在几乎所有当前临床用途中的安全性进行更多研究。在未来几年，生理盐水似乎最终可能会被更安全、更符合生理的晶体液所取代。
