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Crit Care Med:液体复苏过程中的氯离子负荷量越高,患者的死亡风险越高

2016-10-16 MedSci MedSci原创

本研究的目的是调查,复苏过程中使用的液体中的氯含量与患者短期和长期结局的联系。 本研究纳入了接受大容量液体复苏的患者,定义为超过24小时的时间里,接受的液体量超过60 mL/kg。基于大容量液体复苏时液体中氯离子浓度、流体体积等,计算每名患者的氯离子负荷量。比较更高氯离子负荷量 vs 更低氯离子负荷量患者的高氯性酸中毒、急性肾损伤和生存情况。 本研究地点为大学医疗中心,纳入了2000年

本研究的目的是调查,液体复苏过程中使用的液体中的氯含量与患者短期和长期结局的联系。

本研究纳入了接受大容量液体复苏的患者,定义为超过24小时的时间里,接受的液体量超过60 mL/kg。基于大容量液体复苏时液体中氯离子浓度、流体体积等,计算每名患者的氯离子负荷量。比较更高氯离子负荷量 vs 更低氯离子负荷量患者的高氯性酸中毒、急性肾损伤和生存情况。

本研究地点为大学医疗中心,纳入了2000年到2008年入住ICU的患者。

4710例患者接受了大量液体复苏,523(11%)例发生了高氯性酸中毒。未校正混杂因素时,高氯性酸中毒、急性肾损伤、住院死亡率都随着氯离子负荷量的增加而增加(p < 0.001)。校正混杂因素后(包括液体总量、年龄、基线严重程度),氯离子负荷量与高氯性酸中毒或急性肾损伤无关。但是,校正后,氯离子负荷量每增加100 mEq,患者的死亡风险(超过1年)增加5.5%(p = 0.0015)。

结果表明,校正液体总量、年龄、基线严重程度等混杂因素后,大量液体复苏过程中的氯离子负荷量,与患者接下来1年时间的死亡风险有关;不过对高氯性酸中毒或急性肾损伤的影响尚不清楚;还需要进一步的研究阐明为什么氯离子负荷量会影响患者的生存。

原始出处:

Sen, Ayan.et al.Chloride Content of Fluids Used for Large-Volume Resuscitation Is Associated With Reduced Survival.Critical Care Medicine.September 15, 2016

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    2016-10-18 lizhou0204
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