Gille Jochen, Klezcewski Birgit, Malcharek Michael, Raff Thomas, Mogk Martin, Sablotzki Armin, Taha Hischam
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital GmbH Leipzig, Germany.
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital GmbH Leipzig, Germany.
Burns. 2014 Aug;40(5):871-80. doi: 10.1016/j.burns.2013.11.021. Epub 2013 Dec 15.
A variety of crystalloids are available during fluid resuscitation of the severely burnt patient. There is a paucity of literature evidence on the comparative influence of these with regard to clinical outcomes. Significant differences in crystalloids may be clinically relevant given the large volumes employed during shock resuscitation.
The study compared two groups of severely burnt patients (TBSA 20-70%). Prospectively 40 consecutive patients treated with Ringer's acetate (RA group) against a retrospective control group of 40 patients treated with Ringer's lactate (RL group). Outcome parameters analysed included Sequential Organ Failure Assessment (SOFA)-scores at Days 3 and 7 after injury, mortality at 28 and 60 days, electrolyte and renal function, infection rates, cumulative volume administration and duration of ventilator support.
Groups RA and RL were comparable w.r.t. age, total body surface area burn size and ABSI. SOFA-scores on Day 1 of admission also showed no significant difference but were significantly lower in RA group between the 3rd and 6th day. By Day 7 these differences could be attributed as a group effect (P=0.019). In particular low cardiovascular organ function scores contributed to this. Total crystalloid use within the first 28 days were equal in both but differed within the RA group having lower observed volumes of colloid and incidence of blood transfusion. Furthermore group RA had distinctly higher levels of platelets throughout treatment. Elevated lactate levels were noted in RL group during the initial three days. Survival rates at 28 days and 60 days showed no significant difference.
Ringer's acetate solution is a suitable medium for the initial fluid management of the acutely burnt patient. In comparison to Ringer's lactate solution the study revealed lower SOFA-scores for Ringer's acetate solution (ClinicalTrials.gov number, NCT00609700).
在严重烧伤患者的液体复苏过程中，有多种晶体液可供使用。关于这些晶体液对临床结局的比较影响，文献证据较少。鉴于休克复苏期间使用的液体量较大，晶体液的显著差异可能具有临床相关性。
该研究比较了两组严重烧伤患者（烧伤总面积为20%-70%）。前瞻性地连续纳入40例接受醋酸林格液治疗的患者（RA组），与40例接受乳酸林格液治疗的回顾性对照组患者（RL组）进行对比。分析的结局参数包括伤后第3天和第7天的序贯器官衰竭评估（SOFA）评分、28天和60天的死亡率、电解质和肾功能、感染率、累计液体输注量以及机械通气支持时间。
RA组和RL组在年龄、烧伤总面积和急性生理与慢性健康状况评分系统（APACHE）II评分方面具有可比性。入院第1天的SOFA评分也无显著差异，但在第3天至第6天期间，RA组的SOFA评分显著更低。到第7天时，这些差异可归因于分组效应（P = 0.019）。特别是低心血管器官功能评分对此有影响。两组在前28天内的晶体液总用量相等，但RA组观察到的胶体用量和输血发生率较低。此外，在整个治疗过程中，RA组的血小板水平明显更高。在最初三天内，RL组的乳酸水平升高。28天和60天的生存率无显著差异。
醋酸林格液是急性烧伤患者初始液体管理的合适介质。与乳酸林格液相比，该研究显示醋酸林格液的SOFA评分更低（临床试验注册号，NCT00609700）。
