【作者】 刘芳；

【导师】 彭志勇；

【作者基本信息】 武汉大学 ， 重症医学， 2022， 硕士

【摘要】 目的:比较静脉输注醋酸林格氏液和生理盐水对脓毒症患者主要肾脏不良事件(Major Adverse Kidney Events,MAKE)和死亡结局的影响。方法:我们开展了一项单中心、前瞻性、开放标签、平行对照设计的临床试验。本研究招募根据Sepsis3.0诊断为脓毒症的患者,排除了终末期肾病的患者、血氯浓度大于120mmol/L的患者、或在转入重症监护室(Intensive Care Unit,ICU)前6小时内接受超过1000ml液体复苏的患者。受试者在入组后的5天内接受醋酸林格氏液或生理盐水进行静脉补液。研究的主要结局是入组后30天内的MAKE(MAKE30)发生率,次要结局包括入组后30、60、90天死亡率,试验期内的急性肾损伤(Acute Kidney Injury,AKI)发生率、高氯血症发生率,ICU住院时间等。结果:本研究筛查了255例脓毒症患者,最终143例(年龄中位数65[55-71]岁,男性占比69.2%)被纳入研究,其中醋酸林格氏液组73例,生理盐水组70例。两组患者的基线人口学特征、序贯器官衰竭(Sequential Organ Failure,SOFA)评分、急性生理与慢性健康评估(Acute Physiology and Chronic Health Evaluation,APACHE II)评分、入组肾功能无明显差异。30天内,醋酸林格氏液组和生理盐水组分别有17例(23.3%)和14例(20.0%)患者发生MAKE事件,相对危险度为1.2(95%置信区间为0.6-2.2,P=0.69)。另外,两组患者的90天死亡率、AKI发生率、高氯血症发生率、ICU住院天数等均无统计学差异。试验期内,生理盐水组患者呈现出血氯蓄积和AKI进展的趋势。结论:醋酸林格氏液和生理盐水补液对脓毒症患者的MAKE30和死亡率结局未造成显著差异。在使用生理盐水补液的患者中观察到血氯蓄积和AKI进展的趋势,尽管差异无统计学意义。更多还原

【Abstract】 Objective To compare the effect of intravenous acetate Ringer’s solution and saline on the outcome of major adverse kidney events(MAKE)and mortality in septic patients.Methods We conducted a single-center prospective open-label parallel controlled trial which enrolled patients diagnosed with sepsis according to sepsis 3.0.Patients with end-stage renal diseases,whose serum chloride were over 120mmol/L,or who had received fluid resuscitation over 1000 ml within 6 hours prior to intensive care unit(ICU)were excluded.Participants received either acetate Ringer’s solution or saline for intravenous infusion for 5 days after enrollment.The primary outcome was the incidence of MAKE within 30 days(MAKE30).Secondary outcomes included 30-/60-/90-day mortality after enrollment,the incidence of acute kidney injury(AKI)and the incidence of hyperchloremia during the trial period,ICU length of stay,etc.Results There were 255 septic patients who were screened for this trial,143 of whom(median age,65 [55-71],male accounted for 69.2%)were finally enrolled in the study.There were 73 participants in the acetate Ringer’s solution group and 70 in the saline group.There were no significant differences on the baseline demographic characteristics,sequential organ failure(SOFA)scores,acute physiology and chronic health evaluation(APACHE II)scores and renal function at enrollment.There were 17(23.3%)patients ended up with MAKE30 in the Acetate Ringer’s solution group,while there were 14(20.0%)in the saline group.Risk ratio was 1.2(95% confidence interval was 0.6-2.2,P=0.69).Besides,there were no significant differences on 90-day mortality,incidence of AKI,incidence of hyperchloremia,ICU length of stay,etc.During the trial period,there showed a trend of serum chloride accumulation and AKI progression in the saline group.Conclusion There showed no significant difference on the outcome of MAKE30 and mortality in septic patients between intravenous acetate Ringer’s solution and saline.A trend was noticed that saline might increase serum chloride accumulation and AKI progression,although the difference was of no statistical significance.更多还原