Marquez Leonardo, Medellin Sara, Wang Lu, Maheshwari Kamal, Shaw Andrew, Sessler Daniel I
Outcomes Research Consortium, Department of Anesthesiology Cleveland Clinic, Cleveland, OH, United States of America.
Outcomes Research Consortium, Department of Anesthesiology Cleveland Clinic, Cleveland, OH, United States of America; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States of America.
J Clin Anesth. 2025 Feb;101:111744. doi: 10.1016/j.jclinane.2025.111744. Epub 2025 Jan 9.
Postoperative acute kidney injury (AKI) is common after non-cardiac surgery. Normal saline and lactated Ringer's solution are both used for volume replacement during surgery. Normal saline decreases renal blood flow and causes hyperchloremic acidosis whereas lactated Ringer's does not. The incidence of AKI is similar with modest volumes of each fluid. But it remains unclear whether larger volumes of normal saline provoke AKI.
Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group.
Secondary analysis of a single-center multiple cross-over cluster trial.
Intraoperative care.
We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution.
Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution.
The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0-1, 1-2, 3-4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24 h.
The risk of AKI did not differ significantly in patients given 0-1, 1-2, or 3-4 L saline or lactated Ringers solutions. In contrast, patients given 2-3 or > 4 L of lactated Ringer's solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories.
While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. Therefore, either fluid seems reasonable for intraoperative use.
非心脏手术后，术后急性肾损伤（AKI）很常见。手术期间，生理盐水和乳酸林格氏液均用于容量补充。生理盐水会减少肾血流量并导致高氯性酸中毒，而乳酸林格氏液则不会。使用适量的每种液体时，AKI的发生率相似。但大量生理盐水是否会引发AKI仍不清楚。
评估术中晶体液量是否会改变AKI风险与治疗组之间的关系。
单中心多重交叉整群试验的二次分析。
术中护理。
我们纳入了一家大型学术机构中8616名接受结直肠或骨科手术的成年人。
将患者群交替分配至术中使用生理盐水或乳酸林格氏液。
主要结局是作为术中晶体液量（0 - 1、1 - 2、3 - 4或4升以上）和晶体液类型函数的急性肾损伤（AKI）发生率。次要结局是术后头24小时内血清氯浓度的变化。
接受0 - 1升、1 - 2升或3 - 4升生理盐水或乳酸林格氏液的患者中，AKI风险无显著差异。相比之下，接受2 - 3升或超过4升乳酸林格氏液的患者发生AKI的风险高于接受生理盐水的患者。在所有容量类别中，分配至生理盐水组的患者血浆氯浓度逐渐高于接受乳酸林格氏液的患者。
虽然输注生理盐水明显会导致容量依赖性高氯血症，但我们没有发现证据支持大量生理盐水会引发AKI这一理论。因此，两种液体似乎都适合术中使用。
