术中生理盐水量与乳酸林格氏液量对急性肾损伤的影响:SOLAR试验的二次分析。

IF 5 2区 医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2025-02-01 DOI:10.1016/j.jclinane.2025.111744
Leonardo Marquez M.D. , Sara Medellin M.D. , Lu Wang M.S. , Kamal Maheshwari M.D. , Andrew Shaw M.B., F.R.C.A., F.R.C.P.C., M.M.H.C. , Daniel I. Sessler M.D.
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引用次数: 0

摘要

非心脏手术后急性肾损伤(AKI)很常见。手术过程中,生理盐水和乳酸林格氏液都可用于容量置换。生理盐水会减少肾血流量并引起高氯血症性酸中毒,而乳酸林格则不会。两种液体体积适中时,AKI的发生率相似。但仍不清楚大剂量生理盐水是否会引起AKI。目的:评价术中晶体体积是否改变AKI风险与治疗组的关系。设计:单中心多交叉聚类试验的二次分析。设置:术中护理。患者:我们招募了8616名在一家大型学术机构接受过结直肠或骨科手术的成年人。干预措施:患者组术中交替使用生理盐水或乳酸林格氏液。测量:主要结果是急性肾损伤(AKI)发生率与术中晶体体积(0- 1,1 - 2,3 -4或4+升)和晶体类型的关系。我们的次要终点是术后24小时内血清氯浓度的变化。主要结果:给予0- 1,1 -2或3-4 L生理盐水或乳酸林格液的患者发生AKI的风险无显著差异。相比之下,给予2-3或4升乳酸林格氏液的患者发生AKI的风险高于给予生理盐水的患者。在所有容量类别中,给予生理盐水的患者血浆氯浓度逐渐高于给予乳酸林格氏液的患者。结论:虽然生理盐水明显引起容量依赖性高氯血症,但我们没有发现证据支持大量生理盐水引起AKI的理论。因此,两种液体在术中使用似乎都是合理的。
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Volume of intraoperative normal saline versus lactated Ringer's solution on acute kidney injury: A secondary analysis of the SOLAR trial
Postoperative acute kidney injury (AKI) is common after non-cardiac surgery. Normal saline and lactated Ringer's solution are both used for volume replacement during surgery. Normal saline decreases renal blood flow and causes hyperchloremic acidosis whereas lactated Ringer's does not. The incidence of AKI is similar with modest volumes of each fluid. But it remains unclear whether larger volumes of normal saline provoke AKI.

Objective

Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group.

Design

Secondary analysis of a single-center multiple cross-over cluster trial.

Setting

Intraoperative care.

Patients

We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution.

Interventions

Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution.

Measurements

The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0–1, 1–2, 3–4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24 h.

Main results

The risk of AKI did not differ significantly in patients given 0–1, 1–2, or 3–4 L saline or lactated Ringers solutions. In contrast, patients given 2–3 or > 4 L of lactated Ringer's solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories.

Conclusions

While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. Therefore, either fluid seems reasonable for intraoperative use.
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来源期刊
CiteScore
7.40
自引率
4.50%
发文量
346
审稿时长
23 days
期刊介绍: The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.
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