Chaudhary Rahul Kumar, Dhir Ankita, Ganesh Venkata, Singh Ajay, Naik Naveen B, Datta Priyankar Kumar, Soni Shiv Lal, Kaloria Narender, Sakaray Yashwant Raj
Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), Ansari Nagar East, New Delhi, 110029, India.
Eur J Trauma Emerg Surg. 2025 Jan 13;51(1):10. doi: 10.1007/s00068-024-02751-0.
Perioperative metabolic acidosis negatively affects patient outcomes. Perioperative fluid therapy has a clinically significant effect on acid-base balance. This study was conducted to evaluate the effects of isotonic sodium bicarbonate infusion (ISB) versus balanced crystalloid solution (BCS) on perioperative acid-base balance, in terms of postoperative base excess, among patients undergoing emergency laparotomy for perforation peritonitis.
This prospective, randomized, single-center, double-blinded study was conducted in a tertiary hospital from October 2021 to November 2022. A total of 90 patients undergoing emergency laparotomy for perforation peritonitis were randomly assigned to receive either isotonic sodium bicarbonate (ISB) or Ringer's Lactate as a balanced crystalloid solution (BCS) for perioperative maintenance fluid therapy. The primary outcome was to compare the base excess (BE) at the end of surgery. The secondary outcomes were to compare the postoperative clinical outcomes, including the requirement of vasopressors, duration of mechanical ventilation, HDU/ICU stay, the incidence of AKI within seven days, the incidence of re-exploration, and in-hospital mortality. Additionally, pH, PaCO2, HCO3, BE, and lactates intraoperatively and up to 24 h postoperatively were also compared.
The median base excess (BE) values at the end of surgery were significantly better in the ISB group - 4.80 [- 6.80, - 4.10] as compared to the BCS group - 7.30 [- 8.50, - 6.30]. The ISB group had a lower incidence of postoperative AKI (9% ISB versus 24% BCS) and requirement of vasopressors (18% ISB versus 44% BCS). However, there was no major difference between the incidence of re-exploration, length of ICU/HDU stay, and in-hospital mortality.
Infusing isotonic sodium bicarbonate (ISB) for intraoperative maintenance fluid therapy in patients undergoing emergency laparotomy for perforation peritonitis significantly improves perioperative acid-base balance with better postoperative clinical outcomes compared to a balanced crystalloid solution (BCS).
围手术期代谢性酸中毒会对患者预后产生负面影响。围手术期液体治疗对酸碱平衡具有临床显著影响。本研究旨在评估等渗碳酸氢钠输注（ISB）与平衡晶体溶液（BCS）对因穿孔性腹膜炎接受急诊剖腹手术患者围手术期酸碱平衡的影响，以术后碱剩余为指标。
本前瞻性、随机、单中心、双盲研究于2021年10月至2022年11月在一家三级医院进行。共有90例因穿孔性腹膜炎接受急诊剖腹手术的患者被随机分配接受等渗碳酸氢钠（ISB）或乳酸林格氏液作为平衡晶体溶液（BCS）用于围手术期维持液体治疗。主要结局是比较手术结束时的碱剩余（BE）。次要结局是比较术后临床结局，包括血管升压药的使用需求、机械通气时间、在HDU/ICU的住院时间、7天内急性肾损伤的发生率、再次手术的发生率和院内死亡率。此外，还比较了术中及术后24小时内的pH、PaCO2、HCO3、BE和乳酸水平。
与BCS组（-7.30 [-8.50, -6.30]）相比，ISB组手术结束时的碱剩余（BE）中位数显著更好，为-4.80 [-6.80, -4.10]。ISB组术后急性肾损伤的发生率较低（ISB组为9%，BCS组为24%），血管升压药的使用需求也较低（ISB组为18%，BCS组为44%）。然而，再次手术的发生率、ICU/HDU住院时间和院内死亡率之间没有显著差异。
对于因穿孔性腹膜炎接受急诊剖腹手术的患者，术中维持液体治疗输注等渗碳酸氢钠（ISB）与平衡晶体溶液（BCS）相比，能显著改善围手术期酸碱平衡，并具有更好的术后临床结局。
