在接受长期腹部开放手术的患者中,二碳酸和乳酸溶液的有效性:多中心前性随机对照研究
Susu Zhou1,2, Kai Zhao1,2, Chunmei Liu1,2
1Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People's Republic of China.
Drug design, development and therapy
|June 9, 2025
概括
在长时间的腹部手术中,二碳酸林格溶液 (BRS) 和乳酸林格溶液 (LRS) 在维持酸平衡或临床结果方面没有显著差异. 这两种静脉注射液对于患者来说都是安全的.
科学领域:
- 麻醉学和重症监护医学
- 手术流体管理手术流体管理
- 代谢和酸生理学
背景情况:
- 静脉注射液的选择对于在长时间的手术中保持酸平衡至关重要.
- 二碳酸盐灵格溶液 (BRS) 为乳酸盐基溶液提供了替代品,绕过肝脏和脏代谢.
- 了解BRS和乳酸林格溶液 (LRS) 的比较疗效对于优化外科手术期间流体策略至关重要.
研究的目的:
- 调查BRS与LRS在延长腹部开放手术期间对乳酸代谢和酸平衡的影响.
- 为了比较接受BRS和LRS的患者之间的临床结果,包括超乳酸血症的发生率.
- 在接受重大腹部手术的患者中确定影响乳酸度的因素.
主要方法:
- 一个多中心随机对照试验,涉及112名接受开放腹部手术的患者.
- 随机分配患者接受BRS (n=55) 或LRS (n=57).
- 主要结局:术后的高乳酸血症. 二次结果:血清乳酸,酸参数 (pH,BE,BB,HCO3−),葡萄糖,电解质,器官功能和并发症. 使用线性回归分析来确定影响因素.
主要成果:
- 在BRS组 (9.1%) 与LRS组 (19.3%) 相比,术后高乳酸血的发生率较低,但这种差异在统计学上并不显著 (P = 0.177).
- 随着时间的推移,在血清乳酸盐,pH值,基过量,二碳酸盐,葡萄糖或电解质之间没有观察到显著差异.
- 线性回归确定了糖尿病,低血压和血液损失作为影响血液乳酸度的重要因素 (R2 = 0.349,P < 0.001).
结论:
- 二碳酸盐林格溶液和乳酸林格溶液在长期开放腹部手术中用于替代液体是安全的和可比的.
- 两种液体溶液之间没有发现术前乳酸盐水平,酸平衡或临床结果的显著差异.
- 在监测乳酸盐水平时,流体管理策略应考虑患者特定的因素,如糖尿病,低血压和血液损失.
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