Elbers Paul W G, Kooter Jos, van Regenmortel Niels
VUmc, afd. Intensive Care Volwassenen, Amsterdam.
Contact: P.W.G. Elbers (
Ned Tijdschr Geneeskd. 2018 Jun 7;162:D2957.
We previously suggested that choosing balanced solutions over normal saline for fluid therapy might benefit patients. After all, administration of NaCl 0.9% invokes metabolic acidosis and hyperchloraemia which was linked to renal failure and mortality in retrospective studies. Two large randomized controlled clinical trials now confirm this signal. Both in intensive care patients and in the setting of emergency medicine, balanced solutions were shown to reduce the incidence of MAKE30, a composite end point of hospital mortality and indices of renal failure. In addition, predefined subgroup analysis revealed increased mortality for normal saline in intensive care patients with sepsis. Even though the effect size is small in both studies, this evidence against normal saline is hard to ignore, given the immense number of patients who receive NaCl 0.9% worldwide. Therefore, clinical medicine may shortly witness the quiet disappearance of normal saline.
我们之前曾提出，在液体治疗中选择平衡液而非生理盐水可能对患者有益。毕竟，在回顾性研究中，输注0.9%氯化钠会引发代谢性酸中毒和高氯血症，这与肾衰竭和死亡率相关。现在两项大型随机对照临床试验证实了这一迹象。在重症监护患者和急诊医学环境中，平衡液均显示可降低MAKE30（医院死亡率和肾衰竭指标的复合终点）的发生率。此外，预定义的亚组分析显示，在患有脓毒症的重症监护患者中，生理盐水会增加死亡率。尽管两项研究中的效应量都很小，但鉴于全球接受0.9%氯化钠治疗的患者数量巨大，这一反对生理盐水的证据很难被忽视。因此，临床医学可能很快会见证生理盐水悄然退出临床应用。
