Leverve Xavier M, Boon Cindy, Hakim Tarmizi, Anwar Maizul, Siregar Erwin, Mustafa Iqbal
LBFA, INSERM-U884, Université Joseph-Fourier, BP 53 X, 38041 Grenoble Cedex, France.
Intensive Care Med. 2008 Oct;34(10):1796-803. doi: 10.1007/s00134-008-1165-x. Epub 2008 Jun 18.
To compare two solutions for fluid resuscitation in post-coronary artery bypass grafting (CABG) surgery patients: Ringer's lactate (RL) versus a new solution containing half-molar sodium-lactate (HL).
Prospective randomized open label study.
The first 12 h post-CABG surgery in an intensive care unit (ICU).
There were 230 patients enrolled in the study: 208 were analyzed, with 109 from the HL group and 99 from the RL group.
Patients received over the first 12 h post-CABG 10 ml kg BW(-1) HL solution in the HL group versus 30 ml kg BW(-1) of RL solution in the RL group.
Hemodynamic status, body fluid balance and inotrope utilization were compared in the two groups. Post-operative cardiac index increase was significantly higher in HL than in RL (P = 0.02), while mean arterial pressure and other hemodynamic parameters were comparable together with urinary output, indicating similar tissue perfusion in both the groups despite a much lower fluid infusion in the HL group. Therefore, a significant negative fluid balance was achieved in the HL but not in the RL group (-790 +/- 71 vs. +43 +/- 115 mL 12 h(-1), P < 0.0001 for HL and RL, respectively). None of the enrolled patients exhibited side effects related to the treatment.
Half-molar lactate solution is effective for fluid resuscitation in post-CABG patients. Compared to Ringer's Lactate, its use results in a significantly higher cardiac index with less volume being infused, resulting in a very negative post-operative body fluid balance.
比较两种用于冠状动脉旁路移植术（CABG）术后患者液体复苏的溶液：乳酸林格氏液（RL）与含半摩尔乳酸钠的新溶液（HL）。
前瞻性随机开放标签研究。
重症监护病房（ICU）中CABG术后的前12小时。
230名患者纳入研究：分析了208名，其中HL组109名，RL组99名。
HL组患者在CABG术后的前12小时接受10 ml·kg体重⁻¹的HL溶液，而RL组接受30 ml·kg体重⁻¹的RL溶液。
比较两组的血流动力学状态、体液平衡和血管活性药物的使用情况。HL组术后心脏指数的增加显著高于RL组（P = 0.02），而平均动脉压和其他血流动力学参数与尿量相当，表明尽管HL组输液量少得多，但两组的组织灌注相似。因此，HL组实现了显著的负液体平衡，而RL组未实现（-790±71 vs. +43±115 ml·12小时⁻¹，HL和RL分别为P < 0.0001）。所有纳入患者均未表现出与治疗相关的副作用。
半摩尔乳酸溶液对CABG术后患者的液体复苏有效。与乳酸林格氏液相比，使用它可使心脏指数显著更高，输液量更少，从而导致术后体液平衡呈显著负值。
