Comparison of fluid balance and hemodynamic and metabolic effects of sodium lactate versus sodium bicarbonate versus 0.9% NaCl in porcine endotoxic shock: a randomized, open-label, controlled study.
Comparison of fluid balance and hemodynamic and metabolic effects of sodium lactate versus sodium bicarbonate versus 0.9% NaCl in porcine endotoxic shock: a randomized, open-label, controlled study.
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DOI：
10.1186/s13054-017-1694-1
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发表时间：
2017-05-19
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通讯作者：
Favory R
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作者：
Duburcq T;Durand A;Dessein AF;Vamecq J;Vienne JC;Dobbelaere D;Mention K;Douillard C;Maboudou P;Gmyr V;Pattou F;Jourdain M;Tamion F;Poissy J;Mathieu D;Favory R
乳酸钠已被证明可改善血液动力学并避免液体超负荷。本研究的目的是确认乳酸钠输注对液体平衡的有益作用，并说明乳酸盐的优势是否与负氯平衡、其特定代谢或仅与其能量负荷相关。这是一项干预性、随机化、开放标签、对照实验研究。对15头雌性“大白色”猪（2月龄）静脉输注大肠杆菌内毒素进行攻毒。将三组动物（每组5只）随机分配接受不同液体：治疗组接受11.2%乳酸钠（SL组）;等渗对照组接受0.9% NaCl（NC组）;高渗对照组接受8.4%碳酸氢钠（SB组），渗透压摩尔和钠量与SL组相同。为了在三个组中提供相同的能量负荷，对照组灌注相同的能量供应。用非参数检验和用于多重比较的Dunn校正在p < 0.05下进行统计分析。在5小时内测量液体和氯平衡、血流动力学、氧合标志物和微循环参数。SL组的累积液体平衡（550（415-800）mL;中位数（四分位距））显著低于NC组（1100（920-1640）mL，p = 0.01）和SB组（935（790-1220）mL，p = 0.03）。SL组的血流动力学、心脏效率和微循环显著增强，导致氧输送显著改善（SL组在300 min时为417（305-565）mL/min/m2，NC组为207（119-272）mL/min/m2，p = 0.01），SB组为278（211-315）mL/min/m2，p = 0.03）。氧合指标（动脉血氧分压（PaO 2）/吸入氧分数（FiO 2）、混合静脉血氧饱和度（SvO 2）和静脉-动脉二氧化碳张力差（Pv-aCO 2））通过乳酸钠输注增强。两个高渗组的氯平衡相当，与NC组相比显著降低。乳酸钠输注可改善液体平衡和血流动力学。乳酸盐的优势似乎不能用它的能量负荷或随后的水运动引起的负氯平衡来解释。本文的在线版本（doi：10.1186/s13054-017-1694-1）包含补充材料，可供授权用户使用。
Sodium lactate has been shown to improve hemodynamics and avoid fluid overload. The objective of this study was to confirm a beneficial effect on fluid balance with sodium lactate infusion and to specify whether the advantage of lactate is related to a negative chloride balance, its particular metabolism, or simply its energy load. This was an interventional, randomized, open-label, controlled experimental study. Fifteen female “large white” pigs (2 months old) were challenged with intravenous infusion of Escherichia coli endotoxin. Three groups of five animals were randomly assigned to receive different fluids: a treatment group received sodium lactate 11.2% (SL group); an isotonic control group received 0.9% NaCl (NC group); and a hypertonic control group, with the same amount of osmoles and sodium as the SL group, received sodium bicarbonate 8.4% (SB group). In order to provide the same energy load in the three groups, control groups were perfused with an equivalent energy supply. Statistical analysis was performed with non-parametric tests and the Dunn correction for multiple comparisons at p < 0.05. Fluid and chloride balance, hemodynamics, oxygenation markers, and microcirculatory parameters were measured over a 5-h period. Cumulative fluid balance was significantly lower in the SL group (550 (415–800) mL; median (interquartile range)) compared to the NC group (1100 (920–1640) mL, p = 0.01) and the SB group (935 (790–1220) mL, p = 0.03). Hemodynamics, cardiac efficiency, and microcirculation were significantly enhanced in the SL group, resulting in a significant improvement in oxygen delivery (SL group 417 (305–565) mL/min/m2 at 300 min versus the NC (207 (119–272) mL/min/m2, p = 0.01) and the SB (278, (211–315) mL/min/m2, p = 0.03) groups). Oxygenation markers (arterial oxygen partial pressure (PaO2)/inspired oxygen fraction (FiO2), mixed venous oxygen saturation (SvO2), and venoarterial carbon dioxide tension difference (Pv-aCO2) were enhanced with sodium lactate infusion. Chloride balance was equivalent in both hypertonic groups and significantly reduced compared to the NC group. Sodium lactate infusion improves fluid balance and hemodynamics. The advantage of lactate does not seem to be explained by its energy load or by the induced negative chloride balance with subsequent water movements. The online version of this article (doi:10.1186/s13054-017-1694-1) contains supplementary material, which is available to authorized users.