摘要
目的 评价碳酸氢钠林格液用于脓毒症休克患者早期液体复苏的效果.方法 本研究为前瞻性队列研究.纳入2021年4月至2023年4月河北医科大学第二医院麻醉ICU、需要进行早期液体复苏的脓毒症休克患者80例,性别不限,年龄18～80岁,BMI 18～30 kg/m2,分为2组(n=40):乳酸钠林格液组(LR组)和碳酸氢钠林格液组(BR组).2组经3～6 h分别静脉输注30 ml/kg相应晶体液进行复苏后,使用血管升压药物达到复苏目标:CVP 8～12 mmHg;MAP ≥ 65 mmHg;尿量＞0.5 ml·kg-1·h-1;中心静脉血氧饱和度≥0.7.分别于脓毒症休克诊断即刻(复苏前)、液体复苏结束即刻和诊断后6 h时行动脉血气分析;分别于复苏前和诊断后6 h时行血管活性药物评分.分别于复苏前和复苏后24 h时,采用ELISA法测定血浆多配体聚糖-1浓度、血清ALT、AST和Cr浓度.记录28 d全因死亡率.结果 与复苏前比较,BR组复苏结束即刻pH值和HCO3-浓度升高(P＜0.05).与LR组相比,BR组复苏结束即刻HCO3-浓度、乳酸正常率和AST改善率升高(P＜0.05),其余血气分析指标、血管活性药物评分、血浆多配体聚糖-1浓度、血清ALT、AST和Cr浓度及ALT改善率、Cr改善率、28 d全因死亡率差异无统计学意义(P＞0.05).结论 碳酸氢钠林格液用于脓毒症休克患者早期液体复苏效果优于乳酸钠林格注射液.
Abstract
Objective To evaluate the Efficacy of bicarbonate Ringer's solution(BRS)for early fluid resuscitation in patients with septic shock.Methods In this prospective cohort study,80 patients of either sex with septic shock,aged 18-80 yr,with a body mass index of 18-30 kg/m2,who required early fluid resuscitation at the Anesthesiology and Intensive Care Unit of the Second Hospital of Hebei Medical University from April 2021 to April 2023,were included and divided into lactated Ringer's solution group(LR group,n=40)and bicarbonate Ringer's solution group(BR group,n=40).After the corresponding crystalloid solution 30 ml/kg was intravenously infused over 3-6 h for resuscitation,vasopressor drugs were used to achieve the goal of resuscitation:central venous pressure 8-12 mmHg,mean arterial pressure 65 mmHg,urine volume＞0.5 ml·kg-1·h-1,the superior vena cava oxygen saturation≥0.7.Arterial blood gas analysis was performed immediately after the diagnosis of septic shock(before resuscitation),im-mediately after the end of fluid resuscitation and at 6 h after the diagnosis.The vasoactive-inotropic score was calculated.The plasma syndecan-1 concentration and serum alanine aminotransferase(ALT),aspartate aminotransferase(AST)and creatinine(Cr)concentrations were measured by enzyme-linked immunosor-bent assay before resuscitation and at 24 h after resuscitation.The 28-day all-cause mortality was recorded.Results The pH value and HCO3-concentration were significantly increased immediately after the end of resuscitation in BR group compared with the baseline before resuscitation(P＜0.05).Compared with LR group,the HCO3-concentration,normal rate of lactic acid and improvement rate of AST were significantly increased immediately after the end of resuscitation(P＜0.05),and no significant change was found in the other parameters of blood gas analysis,vasoactive-inotropic score,plasma syndecan-1 concentrations,con-centrations of ALT,AST and Cr in serum,improvement rate of ALT,improvement rate of Cr,and 28-day all-cause mortality in BR group(P＞0.05).Conclusions Bicarbonate Ringer's solution is superior to lacta-ted Ringer's solution for early fluid resuscitation in the patients with septic shock.
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