澳大利亚乔治全球健康研究院Simon Finfer团队比较了危重患者使用平衡多电解质溶液与生理盐水补液对预后的影响。相关论文于2022年1月18日发表在《新英格兰医学杂志》上。

危重患者使用平衡多电解质溶液（BMES）是否比使用0.9%氯化钠溶液（生理盐水）更能降低急性肾损伤或死亡的风险尚不确定。

研究组进行了一项双盲、随机、对照试验，他们将重症监护病房（ICU）的危重患者随机分组，分别接受BMES或生理盐水补液治疗90天。主要结局是随机分组后90天内的全因死亡。次要结局是接受新的肾脏替代治疗和ICU期间肌酐水平的最大增幅。

研究组在澳大利亚和新西兰的53个ICU共招募了5037名患者，其中BMES组中2515名，生理盐水组2522名。BMES组2433名患者中有530名（21.8%）在分组后90天内死亡，生理盐水组2413名患者中有530名（22.0%），组间差异不显著。

BMES组2403名患者中有306名（12.7%）开始了新的肾脏替代疗法，生理盐水组2394名患者中有310名（12.9%），组间差异亦不显著。BMES组血清肌酐水平的平均最大增幅为36.6±94.0μmol/L，生理盐水组为36.1±90.2μmol/L，差异不显著。两组之间不良事件和严重不良事件的发生率没有显著差异。

研究结果表明，ICU重症患者使用BMES与生理盐水相比，并不能降低死亡或急性肾损伤风险。

附：英文原文

Title: Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults

Author: Simon Finfer, M.D.,, Sharon Micallef, B.N.,, Naomi Hammond, Ph.D.,, Leanlove Navarra, B.S.N.,, Rinaldo Bellomo, M.D., Ph.D.,, Laurent Billot, M.Res.,, Anthony Delaney, M.D., Ph.D.,, Martin Gallagher, M.D., Ph.D.,, David Gattas, M.D.,, Qiang Li, M.Biostat.,, Diane Mackle, M.N.,, Jayanthi Mysore, M.S.,, Manoj Saxena, M.D., Ph.D.,, Colman Taylor, Ph.D.,, Paul Young, M.D., Ph.D.,, and John Myburgh, M.D., D.Sc.

Issue&Volume: 2022-01-18

Abstract: Background

Whether the use of balanced multielectrolyte solution (BMES) in preference to 0.9% sodium chloride solution (saline) in critically ill patients reduces the risk of acute kidney injury or death is uncertain.

Methods

In a double-blind, randomized, controlled trial, we assigned critically ill patients to receive BMES (Plasma-Lyte 148) or saline as fluid therapy in the intensive care unit (ICU) for 90 days. The primary outcome was death from any cause within 90 days after randomization. Secondary outcomes were receipt of new renal-replacement therapy and the maximum increase in the creatinine level during ICU stay.

Results

A total of 5037 patients were recruited from 53 ICUs in Australia and New Zealand — 2515 patients were assigned to the BMES group and 2522 to the saline group. Death within 90 days after randomization occurred in 530 of 2433 patients (21.8%) in the BMES group and in 530 of 2413 patients (22.0%) in the saline group, for a difference of 0.15 percentage points (95% confidence interval [CI], 3.60 to 3.30; P=0.90). New renal-replacement therapy was initiated in 306 of 2403 patients (12.7%) in the BMES group and in 310 of 2394 patients (12.9%) in the saline group, for a difference of 0.20 percentage points (95% CI, 2.96 to 2.56). The mean (±SD) maximum increase in serum creatinine level was 36.6±94.0 μmol per liter (0.41±1.06 mg per deciliter) in the BMES group and 36.1±90.2 μmol per liter (0.41±1.02 mg per deciliter) in the saline group, for a difference of 0.5 μmol per liter (95% CI, 4.7 to 5.3) (0.01 mg per deciliter [95% CI, 0.05 to 0.06]). The number of adverse and serious adverse events did not differ meaningfully between the groups.

Conclusions

We found no evidence that the risk of death or acute kidney injury among critically ill adults in the ICU was lower with the use of BMES than with saline.

DOI: 10.1056/NEJMoa2114464

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2114464