Atehortúa-López Luis Horacio, Mendoza-Franco Ray, Escobar-Serna José Fernando, Urrego Luis Alejandro, Alzate Fernando, Jaimes Fabian
Hospital Universitario San Vicente Fundación, Medellín, Colombia; Universidad de Antioquia, Medellín, Colombia.
Universidad de Antioquia, Medellín, Colombia.
Arch Cardiol Mex. 2018 Apr-Jun;88(2):100-106. doi: 10.1016/j.acmx.2017.02.004. Epub 2017 Mar 11.
The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and it is also well known that fluid overload increases mortality.
To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery.
The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4mL/kg of HS or NS intravenously for 30min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle.
Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59±14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes.
Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group.
接受心脏手术的患者术后护理通常需要通过静脉输液实现完全康复，但诸如生理盐水等晶体溶液可能会增加间质水肿，而且众所周知，液体超负荷会增加死亡率。
比较7.5%高渗盐水（HS）与0.9%生理盐水（NS）对乳酸清除率的影响，以及心血管搭桥手术后第一天患者的血流动力学反应。
该研究纳入了年龄在18岁及以上、患有冠状动脉疾病和/或心脏瓣膜疾病、接受搭桥手术和/或心脏瓣膜置换术的患者，这些患者一旦入住重症监护病房（ICU），就被随机分配接受4毫升/千克的HS或NS静脉输注30分钟。入住ICU后0、6、12和24小时测量乳酸、动脉血气、心率、中心静脉压和肺楔压。分析采用意向性分析原则。
在总共评估的494例患者中，102例被纳入并分配到HS组（51例患者）或NS组（51例患者）。参与者的平均年龄为59±14岁，男性占59.8%。两组在乳酸清除率或任何次要结局方面均未观察到统计学上的显著差异。
我们的研究未能显示高渗盐水组的乳酸清除率更好，且该组也没有更高不良反应发生率的证据。
