等渗与低渗维持输液疗法对尿量产生，液体平衡和电解质平衡的影响：空腹成人志愿者的交叉研究
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Effect of isotonic versus hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult Volunteers
背景与目的
每天全球数以百万计的成人住院患者，在维持静脉容量中以有限的科学证据为支撑。特别是，液体的性质对液体，钠和氯过载的确定及其有害影响并不清楚。
方 法
这个交叉研究由两个48h的研究阶段组成，其间12个禁食健康成年人用常规溶液（NaCl 0.9％，葡萄糖5％，补充40mmol/L氯化钾）和预混合的低渗液（NaCl 0.32％,葡萄糖5％，含26mmol/L的钾）以每日25ml/kg速率注射。主要终点是累积尿量;并计算了液体平衡。我们还探讨了我们发现的生理机制，并评估了电解质浓度。
结 果
48h后，排除“高血压患者夸大的尿钠排泄物”的异常值后，等渗液体维持输液疗法的尿液比低渗液体减少595ml（95％CI：454-735）（P <0.001），or 803ml(95% CI: 692–915)。等渗溶液处理其特征在于醛固酮明显降低（P <0.001）。等渗中钠浓度较高（P <0.001），但所有测量值均在正常范围内。两种溶液之间的钾浓度没有差异（P = 0.45）。氯化物浓度随着等渗处理而升高（P <0.001），甚至引起高氯血症。
结 论
等渗溶液维持输液疗法的尿量较少，其特征在于醛固酮浓度较低；其容量增加高于低渗溶液，并与高氯血症相关。尽管钠和钾含量均低，但低渗溶液维持输液疗法与低钠血症或低钾血症无关。
原始文献摘要
N. Van Regenmortel.T.De Weerdt,A.H.Van Craenenbroeck,et al.Effect of isotonic versus hypotonic maintenance fluid therapy on urine output, fluid balance,and electrolyte homeostasis:a crossover study in fasting adult Volunteers.Br J Anaesth.2017 Jun 1;118(6):892-900.doi:10.1093/ bja/aex118.
Background.
Daily and globally,millions of adult hospitalized patients are exposed to maintenance i.v.fluid solutions supported by limited scientific evidence.In particular,it remains unclear whether fluid tonicity contributes to the recently established detrimental effects of fluid,sodium,and chloride overload.
Methods
This crossover study consisted of two 48h study periods, during which 12 fasting healthy adults were treated with a frequently prescribed solution (NaCl 0.9% in glucose 5% supplemented by 40mmol litre1 of potassium chloride) and a premixed hypotonic fluid (NaCl 0.32% in glucose 5% containing 26mmol litre1 of potassium) at a daily rate of 25 ml kg1 of body weight.The primary end point was cumulative urine volume; fluid balance was thus calculated.We also explored the physiological mechanisms behind our findings and assessed electrolyte concentrations.
Results.
After 48h,595ml (95% CI:454–735) less urine was voided with isotonic fluids than hypotonic fluids (P<0.001),or 803ml(95% CI: 692-915) after excluding an outlier with 'exaggerated natriuresis of hypertension. The isotonic treatment was characterized by a significant decrease in aldosterone (P<0.001).Sodiumconcentrations were higher in the isotonic arm(P<0.001),but all measurements remained within the normal range. Potassium concentrations did not differ between the two solutions(P=0.45). Chloride concentrations were higher with the isotonic treatment (P<0.001), even causing hyperchloraemia
Conclusions.
Even at maintenance rate,isotonic solutions caused lower urine output,characterized by decreased aldosterone concentrations indicating (unintentional)volume expansion,than hypotonic solutions and were associated with hyperchloraemia.Despite their lower sodium and potassium content,hypotonic fluids were not associated with hyponatraemia or hypokalaemia.
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