改良醋酸林格液与乳酸林格液对围手术期患者结局影响的系统评价

Modified acetate Ringer＇s solutions versus Ringer＇s lactate solutions in perioperative patients： a systematic

目的系统评价改良醋酸林格液与乳酸林格液对围手术期患者结局的影响，为患者选择合理的扩容液体提供依据。方法计算机检索PubMed、EMBASE、循证医学图书馆（CochraneLibrary）、WebofScience服务平台、中国科学引文数据库（CSCD）、中国生物医学文献数据库（CBM）等数据库，检索起止时间为1996年1月至2015年6月。采用Cochrane风险偏倚评价工具评价文章质量，筛选出符合纳入标准的随机对照试验进行Meta分析。结局指标包括：病死率、器官功能障碍发生率、pH值、碱剩余（BE）、二氧化碳分压（PaCO2）、乳酸浓度（Lac）、碳酸氢根（HCO3-）。结果检索到265篇文献，最后进入系统评价为12篇文献，共664例患者。改良醋酸林格液与乳酸林格液相比，两组BE、HCO3-差异无统计学意义。而改良醋酸林格液组pH值高于乳酸林格液组（SMD=0．25，95％CI=0．08～0．42，P=0．04）。乳酸林格液组PaCO：值高于改良醋酸林格液组（SMD=-0．26，95％CI=-0．47～-0．05，P=0．013）。乳酸林格液组乳酸值高于改良醋酸林格液组（SMD=-0．89，95％CI=-1．05-0．73，P=0．ooo）。结论改良醋酸林格液在减少血液乳酸方面优于乳酸林格液。

Objective To systematically review published randomized controlled trials （RCTs） comparing perioperative administration of modified Ringer＇s acetate （PA） versus Ringer＇s lactate solutions （LR） in terms of effect on patient outcomes, so as to provide some evidence for volume expansion. Methods PubMed, EMBASE, Cochrane iibrary, Web of Science, Chinese Science Citation Database （CSCD）, Chinese Biomedic- al Literature Database （CBM） were searched to identify RCTs comparing PA and LR published between January 1996 and June 2015. Cochrane Risk of Bias Tool was applied to assess the quality of literature. The RCTs meeting the criterion of inclusion were selected for meta-analysis. Outcomes included mortality, organ failure, pH, base excess （BE）, partial pressure of carbon dioxide （PaCO2 ）, lactate concentration, and bicarbonate anion （HCO3 -）. Results 265 published papers were searched, from which 12 RCTs （with 654 patients） were eligible according to the inclusion criterion. Mata-analysis showed that there were no statistically significant differences between PA group and LR group in BE and HCO3 ; pH value in the PA group was higher than that in the LR group （P =0. 04） ; PaCO： was higher in the LR （P =0. 013） ; blood lactate concentration was higher in the LR group （P = 0. 000）. Conclusion This study showed that modified Ringer acetate solution may reduce blood lactate concentration compared with Ringer lactate solution. However, the studies included in this review were of poor quality. The evaluation and comparison of these solutions for volume expansion is sub- ject to investigation with high-quality randomised controlled double-blind large trials.