近几十年来,在临床实践中已更换了0.9%NaCl和乳酸林格液等输注溶液。自2017年以来,国家儿童围手术期输液治疗指南推荐平衡等渗溶液以维持液体平衡。平衡输注溶液的组成根据其电解质含量而变化。高氯血症可能被误认为是血容量不足,并可能干扰儿科患者的容量治疗。SterofundinISO®平衡溶液含有127mmol/L氯化物,如果大量给药,可能会导致高氯血症性酸中毒。
目的:本研究的目的是比较StrofundinISO®(SF)治疗与平衡等高线溶液Deltajonin®(DJ)(106mmol/L氯化物)对接受颅面手术的婴儿的酸碱状态的影响。
方法:本回顾性研究,非盲研究包括100名因孤立的非综合征性矢状颅骨融合而接受开颅手术的婴儿.前50名婴儿接受了SterofundinISO®。由于国家准则的变化,2017年,另有50名婴儿将输注更改为异离子Deltajonin®.前值和术后值的氯化物,pH值,碱过量,碳酸氢盐,并测定了白蛋白和磷酸盐,和强离子差异,强离子间隙,阴离子间隙,并计算了弱酸。
结果:两组在年龄方面具有可比性,性别,潜在的疾病,术前电解质(除了3.9±0.3mmol/L的K(SF)与4.1±0.3mmol/L(DJ)和乳酸盐8.7±2.1(SF)与9.6±2.6mmol/L(DJ))。在SterofundinISO®组中,在19例患者中观察到高氯血症代谢性酸中毒,而Deltajonin®组中只有2名婴儿患有高氯血症代谢性酸中毒。术后氯化物水平为111±2.7mmol/L(SF)与108±2.4mmol/L(DJ)。阴离子间隙的差异为12.5±3.0mmol/L(SF)与14.6±2.8mmol/L(DJ),SIDa的差异(明显的强离子差异)为30.9mmol/L(SF)与33.8mmol/L(DJ)。
结论:用高浓度氯化物类晶体如SterofundinISO®进行容量置换可诱发高氯血症性酸中毒。这可以使用Stewart模型来检测。
In recent decades, infusion solutions such as NaCl 0.9% and lactate Ringer\'s solution have been replaced in clinical practice. Since 2017, the national guidelines for perioperative infusion therapy in children recommend balanced isotonic solutions to maintain fluid balance. The composition of balanced infusion solutions varies with respect to their electrolyte content.
Hyperchloremia may be mistaken for hypovolemia and may interfere with volume therapy in pediatric patients. Sterofundin ISO® balanced solution contains 127 mmol/L chloride and may cause hyperchloremic acidosis if administered in large volumes.
OBJECTIVE: The purpose of this study was to compare the effects of Sterofundin ISO® (SF) therapy with the balanced isochloremic solution Deltajonin® (DJ) (106 mmol/L chloride) on the acid-base status in infants undergoing craniofacial surgery.
METHODS: This retrospective, non-blinded study included 100 infants undergoing craniectomy due to isolated nonsyndromic sagittal craniosynostosis. The first 50 infants received Sterofundin ISO®. Due to changes in national guidelines, the infusion was changed to the isoionic Deltajonin® in an additional 50 infants in 2017. Pre- and postoperative values of chloride, pH, base excess, bicarbonate, and albumin and phosphate were determined, and the strong-ion difference, strong-ion gap, anion gap, and weak acids were calculated.
RESULTS: Both groups were comparable in terms of their age, sex, underlying disease, preoperative electrolytes (except K at 3.9 ± 0.3 mmol/L (SF) vs. 4.1 ± 0.3 mmol/L (DJ) and lactate 8.7 ± 2.1 (SF) vs. 9.6 ± 2.6 mmol/L (DJ)). In the Sterofundin ISO® group, hyperchloremic metabolic acidosis was observed in 19 patients, whereas only 2 infants in the Deltajonin® group had hyperchloremic metabolic acidosis. The postoperative chloride level was 111 ± 2.7 mmol/L (SF) vs. 108 ± 2.4 mmol/L (DJ). The difference in anion gap was 12.5 ± 3.0 mmol/L (SF) vs. 14.6 ± 2.8 mmol/L (DJ), and the difference in SIDa (apparent strong-ion difference) was 30.9 mmol/L (SF) vs. 33.8 mmol/L (DJ).
CONCLUSIONS: Hyperchloremic acidosis can be induced by the volume replacement with high-chloride-concentration crystalloids such as Sterofundin ISO®. This can be detected using the Stewart model.