生理盐水与乳酸林格氏液：生理盐水或乳酸林格氏液（SOLAR）试验。
Saline versus Lactated Ringer's Solution: The Saline or Lactated Ringer's (SOLAR) Trial.
机构信息
From the Department of General Anesthesiology (K.M., A.T., W.A.S.E., K.R., S.B., A.G.K., M.R.R., T.K., G.R.B., A.K.) Department of Outcomes Research (K.M., A.T., N.M., C.M., K.R., H.E., B.C., I.S., G.R.B., D.C., E.J.M., A.K., D.I.S.) Department of Quantitative Health Sciences (N.M., C.M., E.J.M.) Department of Orthopedic Surgery (C.H.-R.), Cleveland Clinic, Cleveland, Ohio the Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida (L.S.) the Division of Anesthesia, Critical Care, and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel (B.C.) the Department of Anesthesia, St. Elizabeth's Medical Center, Boston, Massachusetts (I.S.).
出版信息
Anesthesiology. 2020 Apr;132(4):614-624. doi: 10.1097/ALN.0000000000003130.
BACKGROUND
Both saline and lactated Ringer's solutions are commonly given to surgical patients. However, hyperchloremic acidosis consequent to saline administration may provoke complications. The authors therefore tested the primary hypothesis that a composite of in-hospital mortality and major postoperative complications is less common in patients given lactated Ringer's solution than normal saline.
METHODS
The authors conducted an alternating cohort controlled trial in which adults having colorectal and orthopedic surgery were given either lactated Ringer's solution or normal saline in 2-week blocks between September 2015 and August 2018. The primary outcome was a composite of in-hospital mortality and major postoperative renal, respiratory, infectious, and hemorrhagic complications. The secondary outcome was postoperative acute kidney injury.
RESULTS
Among 8,616 qualifying patients, 4,187 (49%) were assigned to lactated Ringer's solution, and 4,429 (51%) were assigned to saline. Each group received a median 1.9 l of fluid. The primary composite of major complications was observed in 5.8% of lactated Ringer's versus 6.1% of normal saline patients, with estimated average relative risk across the components of the composite of 1.16 (95% CI, 0.89 to 1.52; P = 0.261). The secondary outcome, postoperative acute kidney injury, Acute Kidney Injury Network stage I-III versus 0, occurred in 6.6% of lactated Ringer's patients versus 6.2% of normal saline patients, with an estimated relative risk of 1.18 (99.3% CI, 0.99 to 1.41; P = 0.009, significance criterion of 0.007). Absolute differences between the treatment groups for each outcome were less than 0.5%, an amount that is not clinically meaningful.
CONCLUSIONS
In elective orthopedic and colorectal surgery patients, there was no clinically meaningful difference in postoperative complications with lactated Ringer's or saline volume replacement. Clinicians can reasonably use either solution intraoperatively.
背景
生理盐水和乳酸林格氏液都常用于外科患者。然而，生理盐水输注引起的高氯性酸中毒可能会引发并发症。因此，作者检验了一个主要假设，即在接受乳酸林格氏液治疗的患者中，住院死亡率和主要术后并发症的综合发生率低于接受生理盐水治疗的患者。
方法
作者进行了一项交替队列对照试验，纳入 2015 年 9 月至 2018 年 8 月期间行结肠直肠和骨科手术的成年患者，将其分为乳酸林格氏液组和生理盐水组，每 2 周交替。主要结局是住院死亡率和主要术后肾、呼吸、感染和出血并发症的综合发生率。次要结局是术后急性肾损伤。
结果
在 8616 例符合条件的患者中，4187 例（49%）被分配到乳酸林格氏液组，4429 例（51%）被分配到生理盐水组。每组患者均接受中位数为 1.9 L 的液体。乳酸林格氏液组和生理盐水组的主要复合并发症发生率分别为 5.8%和 6.1%，复合成分的平均估计相对风险为 1.16（95%CI，0.89 至 1.52；P=0.261）。次要结局，即术后急性肾损伤，急性肾损伤网络分期 I-III 与 0 期相比，乳酸林格氏液组发生率为 6.6%，生理盐水组发生率为 6.2%，估计相对风险为 1.18（99.3%CI，0.99 至 1.41；P=0.009，显著性标准为 0.007）。两组间每个结局的绝对差异小于 0.5%，这在临床上没有意义。
结论
在择期骨科和结肠直肠手术患者中，乳酸林格氏液或生理盐水容量替代治疗的术后并发症无临床意义差异。临床医生可以合理地在手术期间使用这两种溶液。
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