Krebbel Holger, Feldheiser Aarne, Müller Olga, Boemke Willehad, Sander Michael, Perka Carsten, Wernecke Klaus-Dieter, Spies Claudia
Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Charité Virchow-Klinikum, Berlin, Germany.
J Int Med Res. 2014 Apr;42(2):468-86. doi: 10.1177/0300060513509548. Epub 2014 Feb 10.
To investigate changes in standard base excess (SBE) when administering two different infusion regimens for elective hip replacement within a goal-directed haemodynamic algorithm.
This prospective, double-blind, randomized, controlled study enrolled patients scheduled for primary hip replacement surgery, who were randomized to receive either an unbalanced crystalloid (chloride: 155.5 mmol/l) or a 1 : 1 mixture of a balanced crystalloid and a balanced colloid (6% w/v hydroxyethyl starch 130/0.42; chloride: 98 and 112 mmol/l, respectively). Fluid management was goal-directed to optimize stroke volume using oesophageal Doppler.
A total of 40 patients (19 female/21 male) participated in the study. After surgery, median (25-75% percentiles) SBE was significantly lower in the unbalanced group compared with the balanced group: -2.0 mmol/l (-3.1 to -1.1) versus -0.4 mmol/l (-1.2 to 0.7), respectively. This difference was mainly due to greater plasma chloride concentrations in the unbalanced group. The amount of study medication required to reach haemodynamic stability (median 1200 ml) did not differ between the two groups.
SBE decreased in the unbalanced group without influence on fluid requirements and haemodynamic stability.
在目标导向血流动力学算法下，研究两种不同输注方案用于择期髋关节置换术时标准碱剩余（SBE）的变化。
这项前瞻性、双盲、随机对照研究纳入计划接受初次髋关节置换手术的患者，将其随机分为接受不平衡晶体液（氯化物：155.5 mmol/L）或平衡晶体液与平衡胶体（6% w/v 羟乙基淀粉 130/0.42；氯化物分别为 98 和 112 mmol/L）1:1 混合液的两组。使用食管多普勒进行目标导向的液体管理以优化每搏输出量。
共有 40 例患者（19 例女性/21 例男性）参与研究。术后，不平衡组的 SBE 中位数（25 - 75%百分位数）显著低于平衡组：分别为 -2.0 mmol/L（-3.1 至 -1.1）和 -0.4 mmol/L（-1.2 至 0.7）。这种差异主要是由于不平衡组血浆氯化物浓度更高。两组达到血流动力学稳定所需的研究用药量（中位数 1200 ml）无差异。
不平衡组的 SBE 降低，且对液体需求和血流动力学稳定性无影响。
