加拿大渥太华大学Monica Taljaard团队近日进行了全院乳酸林格氏液与生理盐水的交叉试验。2025年6月12日出版的《新英格兰医学杂志》发表了这项成果。

在临床上，乳酸林格氏液是否优于生理盐水作为常规静脉输液尚不确定。

在一项开放标签、二期、两序列、横断面、集群随机交叉试验中，研究组指定加拿大安大略省的医院在全院范围内使用乳酸林格氏液或生理盐水，为期12周。经过一段洗脱期后，医院在12周内改用另一种液体。主要结局是指标入院后90天内死亡或再入院的综合结局。次要结局是主要结局的各个组成部分，以及住院时间、指标入院后90天内开始透析、90天内访问急诊科以及出院到非家庭设施。结果数据来自卫生行政数据库。分析是在医院一级进行的，主要估计是与所有参与医院的平均生理盐水相比，使用乳酸林格氏液的效果。

7家医院在试验因2019年疫情而中断之前完成了这两个12周的试验。43626例符合条件的患者获得了主要结局数据。指标入院后90天内死亡或再入院的平均（±SD）发生率乳酸林格液组为20.3±3.5%，生理盐水组为21.4±3.3%(校正差为0.53个百分点；95%置信区间为1.85 ~ 0.79；P = 0.35)。所有次要结局与主要结局一致。无严重不良事件报告。

研究结果表明，在全院范围内使用乳酸林格氏液而非生理盐水的政策并没有导致在入院后90天内死亡或再入院的发生率显著降低。

附：英文原文

Title: A Crossover Trial of Hospital-Wide Lactated Ringer’s Solution versus Normal Saline

Author: Lauralyn McIntyre, Dean Fergusson, Tracy McArdle, Shane English, Deborah J. Cook, Alison E. Fox-Robichaud, Claudio Martin, John Marshall, Michael Pugliese, Kusum Menon, Kednapa Thavorn, Ian D. Graham, Steven Hawken, Akshai Iyengar, Kwadwo Kyeremanteng, Raphael Saginur, Andrew J.E. Seely, Ian G. Stiell, Daniel Bainbridge, Charles Weijer, Monica Taljaard

Issue&Volume: 2025-06-12

Abstract:

BACKGROUND

Whether lactated Ringer’s solution is clinically superior to normal saline for routine intravenous administration of fluids is uncertain.

METHODS

In an open-label, two-period, two-sequence, cross-sectional, cluster-randomized, crossover trial, we assigned hospitals in Ontario, Canada, to use either lactated Ringer’s solution or normal saline hospital-wide for a period of 12 weeks. After a washout period, hospitals switched to the other fluid for 12 weeks. The primary outcome was a composite of death or readmission to the hospital within 90 days after the index admission. Secondary outcomes were the individual components of the primary outcome, as well as the length of stay in the hospital, initiation of dialysis within 90 days after the index admission, a visit to the emergency department within 90 days, and discharge to a facility other than home. Data on outcomes were obtained from health administrative databases. The analyses were conducted at the hospital level, and the primary estimand was the effect of the use of lactated Ringer’s solution as compared with normal saline averaged across all participating hospitals.

RESULTS

Seven hospitals completed both 12-week periods before the trial was interrupted owing to the coronavirus disease 2019 pandemic. Data on the primary outcome were available for 43,626 eligible patients. The mean (±SD) incidence of the composite of death or readmission to the hospital within 90 days after the index admission was 20.3±3.5% with lactated Ringer’s solution and 21.4±3.3% with normal saline (adjusted difference, 0.53 percentage points; 95% confidence interval, 1.85 to 0.79; P=0.35). Results for all secondary outcomes were consistent with those for the primary outcome. No serious adverse events were reported.

CONCLUSIONS

A hospital-wide policy to administer lactated Ringer’s solution rather than normal saline did not result in a significantly lower incidence of death or readmission to the hospital within 90 days after the index admission.

DOI: NJ202506120000003

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2416761