碳酸氢钠平衡盐液对脓毒症患者预后及多糖包被的影响

The effects of Sodium Bicarbonate Ringer’s Solution on the prognosis and endothelial glycocalyx in sepsis patients

目的液体复苏是脓毒症治疗的重要手段,然而最佳的液体选择尚存在争议,本研究旨在探讨碳酸氢钠平衡盐液对脓毒症患者预后及多糖包被的影响。方法本研究为单中心随机对照临床研究,选取2021年7月至2023年6月入住扬州市江都人民医院重症医学科,符合Sepsis 3.0诊断标准的成年脓毒症患者,按照随机数字表随机分配至碳酸氢钠平衡盐液组或生理盐水组,分别接受碳酸氢钠平衡盐液或生理盐水作为液体复苏和液体维持治疗的液体,临床医师根据容量评估决定输注的量及速度,比较两组患者30 d病死率,多个时间点外周血多糖包被降解产物浓度,重症监护病房(ICU)病死率,30 d内主要肾脏不良事件(MAKE30)发生率等临床结局的影响。采用酶联免疫吸附测定测定外周血多糖包被降解产物浓度。计数资料采用χ²检验,计量资料采取独立样本t检验进行统计学分析。结果研究期间共纳入符合入选标准患者67例(碳酸氢钠平衡盐液组32例,生理盐水组35例)。两组间年龄、性别、基础疾病、入组时SOFA评分等基线数据均差异无统计学意义(P>0.05)。碳酸氢钠平衡盐液组患者30 d病死率(28.1%vs.40.0%)、ICU病死率(15.6%vs.20.0%)及MAKE30(31.2%vs.42.9%)低于生理盐水组,但差异无统计学意义(P>0.05)。碳酸氢钠平衡盐液组患者第三天外周血蛋白聚糖-1(1317.3±206.9)pg/mL、透明质酸(75.1±24.9)ng/mL和硫酸乙酰肝素(75.6±13.8)ng/mL水平明显低于生理盐水组[(1514.6±264.9)pg/mL,(96.5±25.4)ng/mL,(85.8±15.8)ng/mL](均P<0.05)。结论脓毒症患者使用碳酸氢钠平衡盐液复苏虽然不能明显降低30 d病死率,但可显著减少多糖包被的降解,减少高氯血症和酸中毒的发生。

Objectives Fluid resuscitation is an important treatment for sepsis.However,the optimal choice of fluid is still controversial.This study aimed to investigate the effect of Sodium Bicarbonate Ringer’s Solution on the outcome of patients with sepsis.Methods This was a single-center,prospective,randomized controlled clinical study,From July 2021 to June 2023,adult patients with Sepsis who met the diagnostic criteria of Sepsis 3.0 admitted to the Department of Critical Care Medicine of Jiangdu People's Hospital of Yangzhou were randomly assigned to the sodium bicarbonate ringer’s solution group or the normal saline group according to the random number table.Patients received either sodium bicarbonate ringer’s solution or normal saline as fluid for resuscitation and maintenance therapy.Clinicians determined the amount and rate of infusion based on volume assessment.The 30-day mortality,the degradation of endothelial glycocalyx degradation products at multiple time points,the mortality in intensive care unit(ICU),the incidence of major adverse renal events(MAKE30)within 30 days,and other clinical outcomes were compared between the two groups.Enzyme-Linked immunosorbent assay was used to determine the concentration of endothelial glycocalyx coating degradation products in peripheral blood.The count data were analyzed byχ2 test,and the measurement data were analyzed by independent sample t test.Results A total of 67 patients who met the inclusion criteria were enrolled during the study(32 patients in the sodium bicarbonate ringer’s solution group and 35 patients in the normal saline group).There were no significant differences in baseline data such as age,gender,underlying diseases,and SOFA score at enrollment between the two groups(P>0.05).The 30-day mortality(28.1%vs.40.0%),ICU mortality(15.6%vs.20.0%)and MAKE30(31.2%vs.42.9%)in the sodium bicarbonate ringer’s solution group were lower than those in the normal saline group,but the differences were not statistically significant(P>0.05).The levels of SCD-1(1317.3±206.9)pg/mL,HA(75.1±24.9)ng/mL and HS(75.6±13.8)ng/mL in the sodium bicarbonate ringer’s solution group were significantly lower than those in the normal saline group[(1514.6±264.9)pg/mL,(96.5±25.4)ng/mL,(85.8±15.8)ng/mL]on the third day(all P<0.05).Conclusion Although the use of sodium bicarbonate ringer’s solution for resuscitation in sepsis patients cannot significantly reduce the 30-day mortality rate,but significantly reduce the degradation of polysaccharide coating,decrease the occurrence of hyperchloremia and acidosis.