Kang Jian, Song Young Joo, Jeon Sujeong, Lee Junghwa, Lee Eunsook, Lee Ju-Yeun, Lee Euni, Bang Jae Seung, Lee Si Un, Han Moon-Ku, Oh Chang Wan, Kim Tackeun
Department of Pharmacy, Seoul National University Bundang Hospital, Seoungnam, Korea.
College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea.
J Korean Neurosurg Soc. 2021 Jul;64(4):534-542. doi: 10.3340/jkns.2020.0262. Epub 2021 May 28.
While balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA.
This study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation.
A total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results.
This study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.
与生理盐水（NS）相比，平衡晶体液（BC）可能是一种具有缓冲系统的相关液体治疗方案，但尚未有关于未破裂颅内动脉瘤（UIA）手术最佳液体的研究。本研究旨在比较NS和BC两种液体治疗方案对接受UIA手术患者代谢和临床结局的影响。
本研究设计为倾向评分匹配的回顾性比较研究，纳入接受UIA夹闭术的成年患者。根据术前液体类型和手术期间给予的液体量将患者组分为NS组和BC组。主要结局定义为术后即刻的电解质失衡和酸中毒。次要结局为重症监护病房（ICU）住院时间以及从手术结束到拔管的持续时间。
本研究共纳入586例患者，分别将293例患者分配至NS组和BC组。术后即刻，NS组血清氯水平显著更高。与NS组相比，BC组酸血症（6.5%对11.6%，p=0.043）和代谢性酸中毒（0.7%对4.4%，p=0.007）的发生率更低。与NS组相比，BC组从手术结束到拔管的持续时间显著更短（250±824对122±372分钟，p=0.016），ICU住院时间也更短（1.37±1.11对1.12±0.61天，p=0.001）。在整个多变量分析中，发现使用BC是术后良好结果的重要因素。
本研究表明，与接受NS的患者相比，在UIA夹闭术中接受BC的患者代谢性酸中毒发生率更低、拔管更早且ICU住院时间更短。因此，对于接受UIA手术的患者，建议使用BC作为围手术期液体。
