在ELGAN中进行流体管理:达到完美的平衡!
Satya Prakash1, Deepika Kainth1, Ankit Verma1
1Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Indian journal of pediatrics
|February 4, 2025
概括
对极低妊娠年龄新生儿 (ELGANs) 进行液体和电解质的管理需要仔细监测. 最初的液体限制和基于协议的方法可以帮助减少这些脆弱婴儿的并发症.
科学领域:
- 新生儿科学 新生儿科学
- 儿科脏病学 儿科脏病学
- 关键护理医学 关键护理医学
背景情况:
- 极低妊娠年龄的新生儿 (ELGANs) 由于皮肤屏障功能不成熟,因此存在独特的液体和电解质管理挑战,导致显著的跨表皮液流失.
- 这些新生儿表现出增加尿液和自然尿液的生理倾向,进一步复杂化了液体平衡.
- 6-12%的初始体重减轻被认为是生理性的,对细胞外体积管理有益.
研究的目的:
- 概述基于ELGANs的基于协议的流体管理策略,基于生理学原则和当前的证据.
- 根据妊娠年龄和临床监测,提供初始液体摄入量和定位的具体建议.
- 突出限制液体摄入量在减少新生儿主要发病率方面的潜在好处.
主要方法:
- 基于估计的皮肤和损失以及目标体重变化,制定流体管理方案.
- 在妊娠26-27周时,以100毫升/千克/天的总液体开始,在妊娠24-25周时,以110毫升/千克/天开始,新生儿在第1天.
- 随后根据体重,尿量和血清的每日监测进行液体调整,并以定义的增量和最高率进行调整.
主要成果:
- 建议的初始流体速率因妊娠年龄而异,具体的每日增量和最大流体速率为第7天.
- 建议在生命的最初几天,每12小时进行一次流体策略修订.
- 强调使用加湿的化器,以最大限度地减少跨表皮液体的损失.
结论:
- 基于协议的流体和电解质管理方法对ELGANs至关重要.
- 密切监测和个性化调整对于优化液体平衡和潜在地减少支气管肺功能失调,PDA和NEC等疾病至关重要.
- 建议对结果进行持续审计,以完善单位特定的流体管理策略,并承认基于试验的有限证据.
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