Liu Jia, Gao Yang, He Ziqing, Zhang Hao, Chen Lijian
Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University Hefei 230022, Anhui, China.
Am J Transl Res. 2023 Aug 15;15(8):5216-5227. eCollection 2023.
To investigate the effect of sodium bicarbonated Ringer's solution (BRS) on lactate metabolism, acid-base balance, and clinical outcomes in elderly patients undergoing gastrointestinal surgery.
A total of 60 elderly patients undergoing gastrointestinal surgery were enrolled in this prospective, randomized controlled study. The participants were randomly assigned to the BRS group (n = 30) or sodium lactated Ringer's solution (LRS) group (n = 30) where they received goal-directed fluid therapy with BRS or LRS, respectively. The primary outcome was the incidence of postoperative hyperlactatemia, whereas the secondary outcomes included pH, bicarbonate, base excess (BE), liver function, and postoperative complications within 30 days. Linear regression was conducted to screen the factors affecting lactate concentration.
After fluid therapy, the probability of hyperlactatemia was lower in the BRS group than in the LRS group (3.3% vs. 40.0%, < 0.001). No significant difference in bicarbonate, pH, and BE was observed between the groups ( > 0.05). Furthermore, the incidence of major complications and the length of hospital stay were not significantly different ( > 0.05). However, the BRS group had a lower risk of minor complications than the LRS group (50.0% vs. 76.7%, = 0.032), particularly in terms of impaired liver function (16.7% vs. 43.3%, = 0.024). Diabetes, hypotension, and volume of LRS infused were highly correlated with lactate concentration.
BRS is more beneficial to the reduction of the incidence of postoperative hyperlactatemia and the risk of minor postoperative complications in elderly patients undergoing gastrointestinal surgery. Therefore, BRS may be a better option for perioperative fluid therapy in elderly patients undergoing gastrointestinal surgery.
探讨碳酸氢钠林格液（BRS）对老年胃肠道手术患者乳酸代谢、酸碱平衡及临床结局的影响。
本前瞻性随机对照研究共纳入60例老年胃肠道手术患者。参与者被随机分为BRS组（n = 30）和乳酸钠林格液（LRS）组（n = 30），分别接受以BRS或LRS为目标导向的液体治疗。主要结局是术后高乳酸血症的发生率，次要结局包括pH值、碳酸氢盐、碱剩余（BE）、肝功能及30天内的术后并发症。进行线性回归以筛选影响乳酸浓度的因素。
液体治疗后，BRS组高乳酸血症的发生率低于LRS组（3.3%对40.0%，<0.001）。两组间碳酸氢盐、pH值和BE无显著差异（>0.05）。此外，主要并发症的发生率和住院时间无显著差异（>0.05）。然而，BRS组轻微并发症的风险低于LRS组（50.0%对76.7%，=0.032），尤其是在肝功能受损方面（16.7%对43.3%，=0.024）。糖尿病、低血压和LRS输注量与乳酸浓度高度相关。
BRS对降低老年胃肠道手术患者术后高乳酸血症的发生率和术后轻微并发症的风险更有益。因此，BRS可能是老年胃肠道手术患者围手术期液体治疗更好的选择。
