Tseng Chien-Hua, Chen Tzu-Tao, Chan Ming-Cheng, Chen Kuan-Yuan, Wu Sheng-Ming, Shih Ming-Chieh, Tu Yu-Kang
Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Front Med (Lausanne). 2021 Dec 13;8:758902. doi: 10.3389/fmed.2021.758902. eCollection 2021.
Lactated Ringers reduced mortality more than saline in sepsis patients but increased mortality more than saline in traumatic brain injury patients. This prospective cohort study was conducted in a medical intensive care unit (ICU) in central Taiwan. We applied standard sepsis evaluation protocol and identified heart, lung, liver, kidney, and endocrine comorbidities. We also evaluated resuscitation response with central venous pressure, central venous oxygen saturation, and serum lactate level simultaneously. Propensity-score matching and Cox regression were used to estimate mortality. The competing risk model compared the lengths of hospital stays with the subdistribution hazard ratio (SHR). Overall, 938 patients were included in the analysis. The lactated Ringers group had a lower mortality rate (adjusted hazard ratio, 0.59; 95% CI 0.43-0.81) and shorter lengths of hospital stay (SHR, 1.39; 95% C.I. 1.15-1.67) than the saline group; the differences were greater in patients with chronic pulmonary disease and small and non-significant in those with chronic kidney disease, moderate to severe liver disease and cerebral vascular disease. The resuscitation efficacy was the same between fluid types, but serum lactate levels were significantly higher in the lactated Ringers group than in the saline group (0.12 mg/dl/h; 95% C.I.: 0.03, 0.21), especially in chronic liver disease patients. Compared to the saline group, the lactated Ringers group achieved target glucose level earlier in both diabetes and non-diabetes patients. Lactate Ringer's solution provides greater benefits to patients with chronic pulmonary disease than to those with chronic kidney disease, or with moderate to severe liver disease. Comorbidities are important in choosing resuscitation fluid types.
在脓毒症患者中，乳酸林格液比生理盐水降低死亡率的效果更好，但在创伤性脑损伤患者中，乳酸林格液比生理盐水增加死亡率的幅度更大。这项前瞻性队列研究在台湾中部的一个医学重症监护病房（ICU）进行。我们应用了标准的脓毒症评估方案，并确定了心脏、肺、肝、肾和内分泌合并症。我们还同时通过中心静脉压、中心静脉血氧饱和度和血清乳酸水平评估复苏反应。采用倾向评分匹配和Cox回归来估计死亡率。竞争风险模型用亚分布风险比（SHR）比较住院时间。总体而言，938名患者纳入分析。乳酸林格液组的死亡率低于生理盐水组（调整后风险比为0.59；95%可信区间为0.43 - 0.81），住院时间也短于生理盐水组（SHR为1.39；95%可信区间为1.15 - 1.67）；在慢性肺病患者中差异更大，而在慢性肾病、中重度肝病和脑血管病患者中差异较小且无统计学意义。不同液体类型之间的复苏效果相同，但乳酸林格液组的血清乳酸水平显著高于生理盐水组（0.12mg/dl/h；95%可信区间：0.03，0.21），尤其是在慢性肝病患者中。与生理盐水组相比，乳酸林格液组在糖尿病和非糖尿病患者中都更早达到目标血糖水平。乳酸林格液对慢性肺病患者的益处大于慢性肾病患者或中重度肝病患者。合并症在选择复苏液体类型时很重要。
