资源匮乏医院急诊剖宫产中输注乳酸林格溶液与生理盐水对比的实用性临床试验
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Ringer's Lactate Versus Normal Saline in Urgent Cesarean Delivery in a Resource-Limited Setting: A Pragmatic Clinical Trial.
背景与目的
晶体溶液常用于剖宫产围术期的液体管理治疗，但几乎没有研究指明产科麻醉中晶体溶液到底该如何选择。因此，我们比较了资源匮乏医院急诊剖宫产中使用乳酸林格溶液（RL）与0.9%生理盐水（NS）后产妇和新生儿血PH值和术后24h内酸中毒的患病率。我们猜测，与NS相比，使用RL能减少产妇和新生儿30%的酸中毒发生率。
方 法
本研究是一项实用性兼前瞻性的随机双盲临床对照试验，收集了2011年9月至2012年5月期间穆拉戈国家转诊医院产房的产妇相关信息，最终，共纳入500名产妇，随机分组后NS组252名和RL组248名，并通过检测术前和术后产妇静脉血气和胎盘脐动脉血气情况进行分析。其中，主要的结局指标是产妇的酸中毒发生率（定义为术前产妇血气正常的情况下术后其静脉血PH低于7.32或剩余碱低于-3），次要结局指标是产妇术后24h内酸中毒的发生率，新生儿的血PH值以及剩余碱含量。本研究的临床试验注册号为NCT01585740。
结 果
NS组和RL组的产妇酸中毒发生率分别为38% 和29%（相对危险度[RR]=1.29;95%置信区间[CI] 1.01-1.66;p=0.04）。产妇术后静脉血PH值低于7.32的发生率中， RL组占19%而NS组占2/3（RR=1.65;95% CI 1.18-2.31;p=0.003）。但两组间术后剩余碱低于-3发生率、术后产妇24h内酸中毒发生率以及新生儿情况的差异并无统计学意义。
结 论
虽然NS的使用增加了代谢性酸中毒发生率，但其仍就可能同RL一样是围术期急诊剖宫产液体管理治疗中一种安全的选择。
原始文献摘要
Ayebale E T, Kwizera A, Mijumbi C, et al. Ringer's Lactate Versus Normal Saline in Urgent Cesarean Delivery in a Resource-Limited Setting: A Pragmatic Clinical Trial.[J]. Anesthesia and analgesia, 2017,125(2):533-539. DOI:10.1213/ANE.0000000000002229
BACKGROUND: Crystalloids are used routinely for perioperative fluid management in cesarean delivery. Few studies have determined the crystalloid of choice in obstetric anesthesia. We compared the effects of Ringer's lactate (RL) versus 0.9% normal saline (NS) on maternal and neonatal blood pH and 24-hour postoperative morbidity in urgent cesarean delivery in a low-resource setting. Our hypothesis was that RL would result in 30% less acidosis than NS.
METHODS: This was a pragmatic prospective double-blind randomized controlled trial in the Mulago National Referral Hospital Labor Ward Theater from September 2011 to May 2012. Five hundred parturients were studied; 252 were randomly assigned to NS and 248 to RL groups. Preoperative and postoperative maternal venous blood gases and placental umbilical arterial cord blood gases were analyzed. The primary outcome was incidence of maternal acidosis, as defined by a postoperative drop in venous pH below 7.32 or reduction in base excess below -3 in a previously normal parturient. Maternal 24-hour postoperative morbidity, neonatal pH, and neonatal base excess were the main secondary outcomes. The study was registered in ClinicalTrials.gov as NCT01585740.
RESULTS: The overall incidence of maternal acidosis was 38% in NS and 29% in RL (relative risk, 1.29; 95% confidence interval, 1.01-1.66; P = .04). Thirty-two percent of parturients in NS experienced a drop in venous pH below 7.32 postoperatively, compared with 19% in RL (relative risk, 1.65; 95% confidence interval, 1.18-2.31; P = .003). The comparative drop in base excess postoperatively below -3 between the 2 groups was not statistically significant. There were no significant differences in the incidence of maternal 24-hour postoperative morbidity events and neonatal outcomes between the 2 groups.
CONCLUSIONS: NS may be a safe choice for intraoperative fluid therapy in urgent cesarean delivery as RL, albeit with an increased incidence of metabolic acidosis.
麻醉学文献进展分享
联系我们