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在非危重成人患者中应用平衡晶体液或生理盐水的比较
Balanced Crystalloids versus Saline in Noncritically Ill Adults


Wesley H. Self ... 其他 • 2018.03.01
相关阅读
• 接受平衡晶体液治疗的患者较少发生肾脏不良事件 • 在危重成人患者中应用平衡晶体液或生理盐水的比较

摘要


背景

平衡晶体液和生理盐水的临床疗效孰优孰劣尚未确定,尤其是对于重症监护病房外的非危重患者。

 

方法

本试验采用单中心、实用性、多重交叉设计,在急诊科成人患者中比较了平衡晶体液(乳酸林格液或复方电解质注射液[勃脉力A])与生理盐水的作用,且该人群随后接受ICU外住院治疗。晶体液类型按自然月分配给当月到急诊科就诊的患者,试验持续16个月,整个急诊科按照每个自然月交替应用平衡晶体液与生理盐水。主要结局是不在医院天数(急诊科就诊后28日内出院后存活天数)。次要结局是30日内主要肾脏不良事件,包括任何原因所致死亡、新增肾脏替代治疗或持续性肾功能障碍(定义为肌酐水平上升至≥基线水平的200%)——所有这些指标均是在出院时或到急诊科就诊后30日截尾,以先到者为准。

 

结果

研究共纳入13,347例患者,在急诊科接受晶体液平均1,079 mL,其中88.3%的患者仅接受被分配的晶体液类型。研究发现,就院外天数而言,平衡晶体液组与生理盐水组之间无差异(中位天数,每组均25日;平衡晶体液组校正比值比,0.98;95% CI,0.92~1.04;P=0.41)。平衡晶体液组30日内主要肾脏不良事件发生率低于生理盐水组(4.7% vs. 5.6%;校正比值比,0.82;95% CI,0.70~0.95;P=0.01)。

 

结论

在急诊科接受静脉输液治疗的非危重成年患者中,平衡晶体液治疗和生理盐水治疗在医院外天数方面无差异(由范德比尔特临床和转化研究所[Vanderbilt Institute for Clinical and Translational Research]等资助;SALT-ED在ClinicalTrials.gov注册号为NCT02614040)。





作者信息

Wesley H. Self, M.D., M.P.H., Matthew W. Semler, M.D., Jonathan P. Wanderer, M.D., Li Wang, M.S., Daniel W. Byrne, M.S., Sean P. Collins, M.D., Corey M. Slovis, M.D., Christopher J. Lindsell, Ph.D., Jesse M. Ehrenfeld, M.D., M.P.H., Edward D. Siew, M.D., Andrew D. Shaw, M.B., Gordon R. Bernard, M.D., et al., for the SALT-ED Investigators*
From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville. Address reprint requests to Dr. Rice at the Department of Medicine, Vanderbilt University Medical Center, T-1218 MCN, 1161 21st Ave. S., Nashville, TN 37232, or at todd.rice@vanderbilt.edu. *A complete list of the SALT-ED investigators is provided in the Supplementary Appendix, available at NEJM.org.

 

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