Astapenko David, Navratil Pavel, Pouska Jiri, Cerny Vladimir
Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Hradec Kralove, Sokolská 581, 500 05, Hradec Kralove, Czech Republic.
Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic.
Perioper Med (Lond). 2020 Dec 10;9(1):40. doi: 10.1186/s13741-020-00171-3.
This systematic review discusses a clinical physiology aspect of chloride in fluid therapy. Crystalloid solutions are one of the most widely used remedies. While generally used in medicine for almost 190 years, studies focused largely on their safety have only been published since the new millennium. The most widely used solution, normal saline, is most often referred to in this context. Its excessive administration results in hyperchloremic metabolic acidosis with other consequences, including higher mortality rates.
Original papers and review articles eligible for developing the present paper were identified by searching online in the electronic MEDLINE database. The keywords searched for included hyperchloremia, hypochloremia, and compound words containing the word "chloride," infusion therapy, metabolic acidosis, renal failure, and review.
A total of 21,758 papers published before 31 May 2020 were identified; of this number, 630 duplicates were removed from the list. Upon excluding articles based on their title or abstract, 1850 papers were screened, of which 63 full-text articles were assessed.
According to the latest medical concepts, dyschloremia (both hyperchloremia and hypochloremia) represents a factor indisputably having a negative effect on selected variables of clinical outcome. As infusion therapy can significantly impact chloride homeostasis of the body, the choice of infusion solutions should always take into account the potentially adverse impact of chloride content on chloremia and organ function.
本系统评价讨论了液体治疗中氯的临床生理学方面。晶体溶液是最广泛使用的治疗方法之一。虽然在医学中普遍使用了近190年，但主要关注其安全性的研究自新千年以来才发表。在这种情况下，最常提到的是使用最广泛的溶液——生理盐水。过量使用会导致高氯性代谢性酸中毒以及其他后果，包括更高的死亡率。
通过在电子MEDLINE数据库中在线搜索，确定了符合撰写本文要求的原始论文和综述文章。搜索的关键词包括高氯血症、低氯血症以及包含“氯”字的复合词、输液治疗、代谢性酸中毒、肾衰竭和综述。
共识别出2020年5月31日前发表的21758篇论文；其中，从列表中删除了630篇重复论文。根据标题或摘要排除文章后，筛选了1850篇论文，其中评估了63篇全文文章。
根据最新的医学概念，氯代谢紊乱（高氯血症和低氯血症）无疑是对临床结局的某些变量产生负面影响的一个因素。由于输液治疗会显著影响人体的氯稳态，输液溶液的选择应始终考虑氯含量对氯血症和器官功能的潜在不利影响。
