Department of Translational Physiology, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Biology, Science Faculty, University of Istanbul, Istanbul, Turkey.
Br J Anaesth. 2016 Oct;117(4):521-528. doi: 10.1093/bja/aew277.
Lactate, acetate, and gluconate are anions used in balanced resuscitation fluids, of which lactate and acetate are considered bicarbonate precursors. This study investigated the role of the liver in the ability of balanced and unbalanced solutions to correct acid-base alterations and renal haemodynamics and microvascular oxygenation in a rat model of resuscitated haemorrhagic shock.
Ringer's lactate, Ringer's acetate, PlasmaLyte, or normal saline were administered following haemorrhagic shock in the presence or absence of a 70% partial liver resection. Renal haemodynamics and microvascular oxygenation (by oxygen-dependent quenching of phosphorescence) were measured as well as concentrations of lactate, gluconate, and acetate in plasma and urine. Kidney wet and dry weight was also assessed.
Partial liver resection resulted in increased liver enzymes compared with control and shock groups (P < 0.01). Haemorrhagic shock decreased systemic and renal perfusion and reduced microvascular kidney oxygenation with lactic acidosis (P < 0.01). Resuscitation with balanced fluids did not fully restore renal oxygenation (P < 0.01). Ringer's acetate and PlasmaLyte increased bicarbonate content and restored pH better than Ringer's lactate or saline after partial liver resection (P < 0.01). Liver resection caused an increase in plasma gluconate after PlasmaLyte resuscitation (P < 0.05).
Acetate-buffered balanced fluids show superior buffering effects compared with Ringer's lactate or saline. Gluconate is partially metabolized by the liver, although it does not contribute to acid-base control because of its excretion in urine. Acetate is metabolized regardless of liver function and may be the most efficient bicarbonate precursor. Lactate infusion tends to overwhelm the metabolism capacity of the residual liver.
乳酸盐、醋酸盐和葡萄糖酸盐是平衡复苏液中的阴离子，其中乳酸盐和醋酸盐被认为是碳酸氢盐的前体。本研究旨在探讨肝脏在平衡和不平衡溶液纠正酸碱改变以及肾血流动力学和微血管氧合方面的作用，该研究采用失血性休克大鼠模型。
在存在或不存在 70%部分肝切除的情况下，给予乳酸林格氏液、醋酸林格氏液、血浆电解质或生理盐水进行复苏。测量肾血流动力学和微血管氧合（通过磷光氧依赖性猝灭），并测量血浆和尿液中乳酸盐、葡萄糖酸盐和醋酸盐的浓度。还评估了肾湿重和干重。
与对照组和休克组相比，部分肝切除导致肝酶升高（P < 0.01）。失血性休克降低了全身和肾灌注，并导致乳酸酸中毒时微血管肾氧合减少（P < 0.01）。平衡液复苏未能完全恢复肾氧合（P < 0.01）。与乳酸林格氏液或生理盐水相比，醋酸林格氏液和血浆电解质在部分肝切除后增加碳酸氢盐含量并更好地恢复 pH 值（P < 0.01）。肝脏切除后，在接受血浆电解质复苏后，血浆葡萄糖酸盐增加（P < 0.05）。
与乳酸林格氏液或生理盐水相比，醋酸盐缓冲的平衡液具有更好的缓冲作用。尽管葡萄糖酸盐部分由肝脏代谢，但由于其在尿液中的排泄，它并不有助于酸碱控制。无论肝功能如何，醋酸盐都会被代谢，并且可能是最有效的碳酸氢盐前体。乳酸盐输注往往会超过剩余肝脏的代谢能力。
