DOI: https://doi.org/10.25284/2519-2078.2(75).2016.84176

Кристалоїднi розчини у дiтей

В. І. Снiсарь, С. В. Егоров

Анотація


Внутрiшньовенна iнфузiйна терапiя останнiм часом має значну тенденцiю свого розвитку. Рекомендацiї Holliday MA, Segar WE., що увiйшли в основу проведення рiдинної терапiї, привели до переважного використання гiпотонiчних розчинiв. Гiпонатрiємiя, яка часто розвивається у дiтей i має ряд серйозних ускладнень, була викликана, в основному, їх використанням. Щоб уникнути розвитку гострої гiпонатрiємiї, було рекомендовано внутрiшньовенне введення 0,9% NaCl. Однак, кислотно-основнi порушення за рахунок розвитку гiперхлоремiчного ацидозу обмежують його застосування. 

В останнi роки створюються i активно застосовуються розчини, що не тiльки сприяють корекцiї водного балансу, електролiтних порушень, кислотно-основного стану, але i володiють органопротективним ефектом, що, безумовно, дуже важливо. Тому використання збалансованих сольових розчинiв якостi iзотонiчної рiдиниви бору, повинно мати перевагу перед введенням 0,9% фiзiологiчного розчину.

Мета даного огляду надати короткий виклад нинiшньої концепцiї для внутрiшньовенного введення рiдини в педiатричних вiддiленнях iнтенсивної терапiї. Викладено певнi постулати, яких потрiбно дотримуватися, призначаючи дитинi внутрiшньовенну рiдину. Описанi певнi переваги i недолiки сольових розчинiв, якi застосовуються у дiтей. Бiльшою мiрою порiвнюється 0,9% NaCl iз збалансованим iзотонiчним сольовим розчином Стерофундiном. Вiн має концентрацiю натрiю (140 ммоль/л) i значно бiльш низьку концентрацiю хлориду (127 ммоль/л), а також калiй, магнiй, що бiльш наближене до складу плазми. В оглядi представленi данi по сольовому розчину Рiнгер-лактат, який має дещо знижену концентрацiю натрiю (131 ммоль/л) у порiвняннi з нормальним фiзiологiчним розчином i Стерофундiном. Низька концентрацiя натрiю i вмiст лактату дещо обмежують його застосування, особливо при нейрохiрургiчнiй патологiї.


Ключові слова


Діти; збалансовані сольові розчини; внутрішньовенна інфузія рідини

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