DOES INTRAVENOUS LACTATED RINGER'S SOLUTION RAISE SERUM LACTATE?
DOES INTRAVENOUS LACTATED RINGER'S SOLUTION RAISE SERUM LACTATE?
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DOI：
10.1016/j.jemermed.2018.05.031
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发表时间：
2018-09-01
影响因子：
1.5
通讯作者：
Khan, Memona
中科院分区：
文献类型：
--
作者：
Zitek, Tony;Skaggs, Zachary D.;Khan, Memona
背景：血清乳酸在严重脓毒症和休克状态下升高，但其解释可能受到混杂因素的影响。乳酸林格氏液（LR）用于脓毒症患者的复苏，含有28mmol /L乳酸钠。目的：我们试图确定30ml /kg LR是否会增加血清乳酸水平。方法：在这项双盲、随机对照试验中，30名志愿者被分配接受30ml /kg静脉LR或生理盐水（NS）。在给药前后测定血清乳酸水平。主要结果是LR组和NS组之间乳酸变化的差异。其次，我们评估了每组的pH值、碳酸氢盐、钠和氯化物的变化。结果：静脉滴注LR 30 mL/kg后，血清乳酸水平平均升高0.93 mmol/L（95%可信区间0.42 ~ 1.44 mmol/L）。然而，NS组的平均血清乳酸水平也有小幅升高，为0.37 mmol/L(95%可信区间为-0.26 mmol/L ~ 1.00 mmol/L)，因此LR组与NS组的乳酸变化差异无统计学意义（p = 0.2）。与LR组相比，NS组的pH值和碳酸氢盐下降幅度更大，氯化物增加幅度更大。结论：在健康个体中，服用30cc /kg LR后，平均血清乳酸水平有适度但显著的升高。30 mL/kg NS与LR相比，平均血清乳酸水平没有差异。(C) 2018爱思唯尔公司版权所有。
Background: Serum lactate increases in states of severe sepsis and shock, but its interpretation may be subject to confounders. Lactated Ringer's solution (LR) is used in the resuscitation of septic patients and contains 28 mmol/L of sodium lactate. Objectives: We sought to determine if a bolus of 30 mL/kg of LR increases serum lactate levels. Methods: In this double-blind, randomized controlled trial, 30 volunteers were assigned to receive either 30 mL/kg of intravenous LR or normal saline (NS). Serum lactate was measured before and after the fluid bolus. The primary outcome was the difference in the change in lactate between the LR and NS groups. Secondarily, we assessed the change in pH, bicarbonate, sodium, and chloride in each group. Results: After 30 mL/kg of intravenous LR, the mean serum lactate level increased by 0.93 mmol/L (95% confidence interval 0.42-1.44 mmol/L). However, there was also a small increase in the mean serum lactate level in the NS group of 0.37 mmol/L (95% confidence interval -0.26 mmol/L to 1.00 mmol/L), such that there was not a statistically significant difference in the change in lactate when comparing the LR group to the NS group (p = 0.2). The NS group saw larger declines in pH and bicarbonate and greater increases in chloride compared with the LR group. Conclusion: In healthy individuals, a modest but significant rise in mean serum lactate was seen after a 30 cc/kg LR bolus. There was no difference in mean serum lactate when comparing a 30 mL/kg bolus of NS to LR. (C) 2018 Elsevier Inc. All rights reserved.