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在危急疾病中平衡和葡萄糖:关于稀释剂策略和ICU结果的10年研究
Payam Rahimi1, Furkan Tontu2, Batoul Khoundabi3
1Bakırköy Dr. Sadi Konuk Training and Research Hospital, 34147 Istanbul, Turkey.
Journal of clinical medicine
|December 11, 2025
概括
在重症监护室 (ICU) 用德克斯特代替盐水,以稀释药物,降低了患者死亡率,改善了酸平衡. 这种节约的策略需要在重症患者中仔细监测血糖.
科学领域:
- 关键护理医学 关键护理医学
- 临床化学 临床化学
- 流体和电解质管理管理
背景情况:
- 高的静脉注射液,如0.9%盐水,在ICU中很常见,可能导致高血和代谢性酸症.
- 过多的化物对强离子差异 (SID) 有负面影响,可能会使患者的结果恶化.
- 这项研究调查了从盐水转换为乳糖作为ICU中的稀释剂的临床影响.
研究的目的:
- 评估节约稀释剂策略 (5%乳糖) 与基于盐酸的策略对ICU结果的影响.
- 在稀释剂策略改变后,评估酸平衡,死亡率和其他临床参数的变化.
主要方法:
- 对4347名成人ICU患者进行回顾性队列研究,需要机械通风≥12小时.
- 基于盐水的稀释剂期 (2015-2018) 和基于化物节约的乳糖期 (2019-2025) 的结果比较.
- 分析包括人口统计,并发症,疾病严重程度得分 (APACHE II,SOFA),液体暴露,SID和48小时内的实验室值;多变量逻辑回归确定了死亡率预测因素.
主要成果:
- 在采用具有相似功能的化物节约稀释剂后,死亡率从44.6%降至39.2% (绝对减少5.4%,p=0.003).
- 乳糖组的SID较高 (39比38毫摩尔/升),化物含量较低,酸概况改善.
- 化物水平与盐酸时代的死亡率密切相关 (12-13%增加的几率/mmol/L),在乳糖时代减弱 (2%/mmol/L);SID作为酸平衡的标志物得到改善.
结论:
- 在ICU中过渡到节稀释剂与降低死亡率和更好的酸状态有关,而不会损害功能.
- 在使用基于乳糖的稀释剂时,增加的葡萄糖水平需要保持警的血糖监测.
- 这些发现支持在重症监护机构采用含节约策略,并仔细控制血糖水平.
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