Sundaram Senthil Kumaran, Panda Nidhi Bidyut, Kaloria Narender, Soni Shiv Lal, Mahajan Shalvi, Karthigeyan Madhivanan, Pattanaik Smita, Singh Sheetal, Dey Sumit, Pal Arnab, Tripathi Manjul
Department of Anaesthesia and Intensive Care, Post Graduate, Institute of Medical Education and Research, Chandigarh, India.
Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Asian J Neurosurg. 2024 Jun 13;19(3):386-394. doi: 10.1055/s-0044-1787086. eCollection 2024 Sep.
Neurosurgical patients often receive 0.9% normal saline (NS) during the perioperative period. Theoretically, a balanced salt solution (BSS) is better than 0.9% saline. We compared the effects of two different fluids on acid-base balance, renal function, and neurological outcome in patients who underwent clipping following subarachnoid hemorrhage from a ruptured intracranial aneurysm. Patients in group NS ( = 30) received 0.9% saline and group BSS ( = 30) received BSS (Plasmalyte-A) in the perioperative period for 48 hours. Comparison of arterial pH, bicarbonate, and base deficit measured preoperatively, intraoperatively (first and second hour), and postoperatively (at 24 and 48 hours) was the primary outcome of the study. The secondary outcome compared serum electrolytes, renal function tests, urine neutrophil gelatinase-associated lipocalin (NGAL), serum cystatin C, and the neurological outcome using modified Rankin score (MRS) at discharge, 1, and 3 months. In group NS, significantly low pH at 1-hour intraoperative period was seen compared with group BSS (7.37 ± 0.06 vs. 7.40 ± 0.05, = 0.024). The bicarbonate level in group NS was significantly lower and the base deficit was higher at second intraoperative hour (bicarbonate: 17.49 vs. 21.99 mEq/L, = 0.001; base deficit: 6.41 mmol/L vs. 1.89 mmol/L, = 0.003) and at 24 hours post-surgery (bicarbonate: 20.38 vs. 21.96 mEq/L, = 0.012; base deficit: 3.56 mmol/L vs. 2.12 mmol/L, = 0.034)). Serum creatinine was higher in group NS at 24 hours (0.66 vs. 0.52 mg/dL, = 0.013) and 48 hours (0.62 vs. 0.53 mg/dL, = 0.047). Serum urea, electrolytes, cystatin, urine NGAL, and MRS were comparable. In neurosurgical patients undergoing clipping for ruptured intracranial aneurysm, using a BSS during the perioperative period is associated with a better acid-base and renal profile. However, the biomarkers of kidney injury and long-term outcomes were comparable.
神经外科患者在围手术期常输注0.9%的生理盐水（NS）。理论上，平衡盐溶液（BSS）优于0.9%的生理盐水。我们比较了两种不同液体对颅内动脉瘤破裂蛛网膜下腔出血患者夹闭术后酸碱平衡、肾功能和神经功能转归的影响。NS组（n = 30）患者在围手术期48小时内输注0.9%的生理盐水，BSS组（n = 30）患者输注BSS（Plasmalyte - A）。术前、术中（第1小时和第2小时）及术后（24小时和48小时）测量的动脉pH值、碳酸氢盐和碱缺失的比较是本研究的主要结局。次要结局比较血清电解质、肾功能检查、尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、血清胱抑素C，以及出院时、1个月和3个月时使用改良Rankin量表（MRS）评估的神经功能转归。与BSS组相比，NS组在术中1小时pH值显著降低（7.37±0.06 vs. 7.40±0.05，P = 0.024）。NS组在术中第2小时（碳酸氢盐：17.49 vs. 21.99 mEq/L，P = 0.001；碱缺失：6.41 mmol/L vs. 1.89 mmol/L，P = 0.003）和术后24小时（碳酸氢盐：20.38 vs. 21.96 mEq/L，P = 0.012；碱缺失：3.56 mmol/L vs. 2.12 mmol/L，P = 0.034）时碳酸氢盐水平显著降低，碱缺失更高。NS组在24小时（0.66 vs. 0.52 mg/dL，P = 0.013）和48小时（0.62 vs. 0.53 mg/dL，P = 0.047）时血清肌酐更高。血清尿素、电解质、胱抑素、尿NGAL和MRS相当。对于接受颅内动脉瘤夹闭术的神经外科患者，围手术期使用BSS与更好地维持酸碱平衡和肾功能相关。然而，肾损伤生物标志物和长期结局相当。
