Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Clin Nutr. 2023 Nov;42(11):2270-2281. doi: 10.1016/j.clnu.2023.09.029. Epub 2023 Oct 3.
This review summarises some of my work on fluid and electrolyte balance over the past 25 years and shows how the studies have influenced clinical practice. Missing pieces in the jigsaw are filled in by summarising the work of others. The main theme is the biochemical, physiological and clinical problems caused by inappropriate use of saline solutions including the hyperchloraemic acidosis caused by 0.9% saline. The importance of accurate and near-zero fluid balance in clinical practice is also emphasised. Perioperative fluid and electrolyte therapy has important effects on clinical outcome in a U-shaped dose response fashion, in which excess or deficit progressively increases complications and worsens outcome. Salt and water overload, with weight gain in excess of 2.5 kg worsens surgical outcome, impairs gastrointestinal function and increases the risk of anastomotic dehiscence. Hyperchloraemic acidosis caused by overenthusiastic infusion of 0.9% saline leads to adverse outcomes and dysfunction of many organ systems, especially the kidney. Salt and water deficit causes similar adverse effects as fluid overload at the cellular level and also leads to worse outcomes. Serum albumin is shown to be affected mainly by dilution and inflammation and is not a good nutritional marker. These findings have been incorporated in the British consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP) and National Institute for Health and Care Excellence (NICE) guidelines on intravenous fluid therapy in adults in hospital and are helping change clinical practice and improve outcomes.
这篇综述总结了我在过去 25 年中关于液体和电解质平衡的部分工作，并展示了这些研究如何影响临床实践。通过总结其他人的工作来填补拼图中的缺失部分。主题是由不适当使用盐水溶液引起的生化、生理和临床问题，包括 0.9%盐水引起的高氯性酸中毒。还强调了在临床实践中实现准确且接近零的液体平衡的重要性。围手术期液体和电解质治疗以 U 形剂量反应方式对临床结果有重要影响，其中过多或不足会逐渐增加并发症并恶化结果。盐和水超负荷，体重增加超过 2.5 公斤，会恶化手术结果，损害胃肠道功能并增加吻合口裂开的风险。由于过度热衷于输注 0.9%盐水而引起的高氯性酸中毒会导致许多器官系统的不良后果和功能障碍，尤其是肾脏。盐和水不足会在细胞水平上产生类似的不良影响，并导致更糟糕的结果。白蛋白显示主要受稀释和炎症的影响，不是良好的营养标志物。这些发现已被纳入英国成人外科患者静脉输液治疗共识指南（GIFTASUP）和国家卫生与保健卓越研究所（NICE）关于成人住院静脉输液治疗的指南，并正在帮助改变临床实践和改善结果。
