醋酸鹽與乳酸鹽緩衝晶體溶液：Meta分析和試驗序貫分析的系統評價

貴州醫科大學    麻醉與心臟電生理課題組

翻譯：馬艷燕  編輯：馬艷燕  審校：曹瑩

目的

在臨床實踐中廣泛使用緩衝晶體溶液。然而，指南沒有區分特定類型的緩衝溶液和臨床平衡。本研究旨在評估醋酸鹽與乳酸鹽緩衝溶液對住院患者的益處和不良影響。

方法

我們進行了一項系統評估，對隨機臨床試驗進行Meta分析和試驗序貫分析，評估醋酸鹽與乳酸鹽緩衝溶液在住院成人和兒童患者中靜脈內給藥中的應用。主要結局指標是全因短期死亡率。我們遵守已公佈的規程、系統回顧和Meta分析首選報告項目(PRISMA)聲明、《Cochrane 手冊》以及建議、評估、發展和評價(GRADE)方法的分級。

結果

本研究納入五項隨機對照試驗，招募390名患者。我們發現，在醋酸鹽緩衝溶液和乳酸鹽緩衝溶液之間，短期死亡率(隨機效應，RR＝0.29；95%CI 0.06-1.51，p=0.14， I2=0%)或住院時間(隨機效應，D＝-1.31，95%CI 3.66-1.05，p=0.28，I2=0%)差異無統計學意義。證據品質非常低。三項試驗報告了關於重症監護病房LOS的數據，一項試驗報告了血管加壓藥治療的持續時間;這些數據都不允許在meta分析中匯集。沒有試驗報告有關長期死亡率、健康相關生活品質、不良事件、機械通氣持續時間或腎臟替代治療的數據。

 結論：在這項系統性綜述中，我們發現在住院患者中使用醋酸鹽緩衝溶液與乳酸緩衝溶液的證據數量和品質都很低。

原始文獻來源：Ellekjaer KL, Perner A, Sivapalan P, Møller MH. Acetate- versus lactate-buffered crystalloid solutions: A systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiol Scand. 2022;1‐13.

    英文原文      

Acetate- versus lactate-buffered crystalloid solutions: A systematic review with meta-analysis and trial sequential analysis

Objective: There is a widespread use of buffered crystalloid solutions in clinical practice. However, guidelines do not distinguish between specific types of buffered solutions and clinical equipoise exists. We aimed to assess the desirable and undesirable effects of acetate- versus lactate-buffered solutions in hospitalised patients. 

Methods: We conducted a systematic review with meta-analysis and trial sequential analysis of randomised clinical trials assessing the use of acetate- versus lactatebuffered solutions for intravenous administration in hospitalised adults and children. The primary outcome was all-cause short-term mortality. We adhered to our published protocol, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. 

Results: We included five RCTs enrolling 390 patients. We found no statistically significant difference in short-term mortality (random effects, risk ratio [RR] 0.29; 95% confidence interval [CI] 0.06–1.51, p = .14, I2 = 0%) or hospital length of stay (LOS) (random effects, mean difference [MD]—1.31, 95% CI  3.66 to 1.05, p = .28, I2 = 0%) between acetate- versus lactate-buffered solutions. The quality of evidence was very low. Data regarding intensive care unit LOS were reported by three trials and duration of vasopressor treatment by one trial; none of these data allowed for pooling in metaanalyses. No trials reported data on long-term mortality, health-related quality of life, adverse events, duration of mechanical ventilation or renal replacement therapy. 

Conclusion: In this systematic review, we found very low quantity and quality of evidence on the use of acetate- versus lactate-buffered solutions in hospitalised patients.

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