PDF(Pubmed)
Abstract：
Acute electrolyte and acid-base imbalance is experienced by many children following kidney transplant. This is partly because doctors give very large volumes of artificial fluids to keep the new kidney working. When severe, fluid imbalance can lead to seizures, cerebral edema and death. In this pragmatic, open-label, randomized controlled trial, we randomly assigned (1:1) pediatric kidney transplant recipients to Plasma-Lyte-148 or standard of care perioperative intravenous fluids (predominantly 0.45% sodium chloride and 0.9% sodium chloride solutions). We then compared clinically significant electrolyte and acid-base abnormalities in the first 72 hours post-transplant. The primary outcome, acute hyponatremia, was experienced by 53% of 68 participants in the Plasma-Lyte-148 group and 58% of 69 participants in the standard fluids group (odds ratio 0·77 (0·34 - 1·75)). Five of 16 secondary outcomes differed with Plasma-Lyte-148: hypernatremia was significantly more frequent (odds ratio 3·5 (1·1 - 10·8)), significantly fewer changes to fluid prescriptions were made (rate ratio 0·52 (0·40-0·67)), and significantly fewer participants experienced hyperchloremia (odds ratio 0·17 (0·07 - 0·40)), acidosis (odds ratio 0·09 (0·04 - 0·22)) and hypomagnesemia (odds ratio 0·21 (0·08 - 0·50)). No other secondary outcomes differed between groups. Serious adverse events were reported in 9% of participants randomized to Plasma-Lyte-148 and 7% of participants randomized to standard fluids. Thus, perioperative Plasma-Lyte-148 did not change the proportion of children who experienced acute hyponatremia compared to standard fluids. However fewer fluid prescription changes were made with Plasma-Lyte-148, while hyperchloremia and acidosis were less common.
摘要：
肾脏移植后，许多儿童经历了急性电解质和酸碱失衡。部分原因是医生提供了大量的人工液体来保持新的肾脏工作。严重时,体液失衡会导致癫痫发作,脑水肿和死亡。在这种务实的情况下，开放标签，随机对照试验,我们将(1:1)小儿肾移植受者随机分配至血浆-Lyte-148或标准护理围手术期静脉输液组(主要为0.45%氯化钠和0.9%氯化钠溶液).然后，我们比较了移植后最初72小时内临床上有意义的电解质和酸碱异常。主要结果，急性低钠血症,Plasma-Lyte-148组68名参与者中53%的参与者和标准液体组69名参与者中58%的参与者(比值比0·77(0·34-1·75))。16个次要结局中有5个与血浆-Lyte-148不同：高钠血症明显更频繁（比值比3·5（1·1-10·8）），液体处方的变化明显较少(比率为0·52(0·40-0·67))，经历过高氯血症的参与者明显较少(赔率比0·17(0·07-0·40))，酸中毒（比值比0·09（0·04-0·22））和低镁血症（比值比0·21（0·08-0·50））。组间没有其他次要结果的差异。9％的参与者被随机分配到血浆-Lyte-148，7％的参与者被随机分配到标准液体。因此，与标准液体相比,围手术期血浆-Lyte-148未改变急性低钠血症患儿的比例.然而，Plasma-Lyte-148的液体处方更改较少，而高氯血症和酸中毒则较少见。
