Great Ormond Street Hospital, London, UK.
University College London Institute of Child Health, London, UK.
Pediatr Nephrol. 2019 Jul;34(7):1191-1199. doi: 10.1007/s00467-018-4008-1. Epub 2018 Jul 9.
Intravenous 0.9% saline has saved countless lives since it was introduced over a century ago. It remains the most widespread crystalloid in both adult and pediatric practice. However, in recent years, evidence of deleterious effects is accruing. These include increased mortality, acute kidney injury (AKI), metabolic acidosis, and coagulopathy. The predominant cause for these sequelae appears to be the excess chloride concentration of 0.9% saline relative to plasma. This has led to development of balanced isotonic solutions such as PlasmaLyte. This review summarizes current evidence for adverse effects of chloride-rich intravenous fluid and considers whether 0.9% saline should still be used in 2018 or abandoned as a historical treatment in favor of balanced crystalloid solutions.
自一个多世纪前问世以来，静脉注射 0.9%生理盐水挽救了无数生命。它仍然是成人和儿科实践中最广泛使用的晶体液。然而，近年来，越来越多的证据表明它存在有害影响。这些影响包括死亡率增加、急性肾损伤 (AKI)、代谢性酸中毒和凝血功能障碍。这些后果的主要原因似乎是相对于血浆而言，0.9%生理盐水的氯浓度过高。这导致了平衡等渗溶液的发展，如 PlasmaLyte。本综述总结了富含氯的静脉输液的不良影响的现有证据，并考虑在 2018 年是否仍应使用 0.9%生理盐水，或者是否应将其摒弃作为历史治疗方法，转而使用平衡晶体溶液。
