[NEJM在线发表]:SMART研究显示,危重病成年患者使用平衡盐溶液能够减少不良预后发生率 | 中国病理生理学会危重病医学专业委员会
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2018年03月02日 时讯速递, 进展交流 暂无评论

Balanced Crystalloids versus Saline in Critically Ill Adults

Matthew W. Semler, Wesley H. Self, Jonathan P. Wanderer, et al

N Engl J Med February 27, 2018

DOI: 10.1056/NEJMoa1711584



Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes.



In a pragmatic, cluster-randomized, multiple-crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted. The primary outcome was a major adverse kidney event within 30 days — a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) — all censored at hospital discharge or 30 days, whichever occurred first.

这项实效性、群组随机、多重交叉临床试验在一个医学中心的5个ICU中进行。根据收治ICU的随机分组情况,15802名成年患者分别接受生理盐水(0.9% 氯化钠)或平衡盐溶液(乳酸林格氏液或Plasma-Lyte)输注。主要预后终点为30天内重要不良肾脏事件—这是一个复合终点,包括任何原因导致死亡,新发肾脏替代治疗或持续肾脏功能障碍(定义为肌酐水平叫基线值升高≥200%)—所有指标均在出院或30天截尾。


Among the 7942 patients in the balanced-crystalloids group, 1139 (14.3%) had a major adverse kidney event, as compared with 1211 of 7860 patients (15.4%) in the saline group (marginal odds ratio, 0.91; 95% confidence interval [CI], 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P=0.04). In-hospital mortality at 30 days was 10.3% in the balanced-crystalloids group and 11.1% in the saline group (P=0.06). The incidence of new renal-replacement therapy was 2.5% and 2.9%, respectively (P=0.08), and the incidence of persistent renal dysfunction was 6.4% and 6.6%, respectively (P=0.60).

在平衡盐溶液组的7942名患者中,1139名(14.3%) 发生重要不良肾脏事件,生理盐水组7869名中 1211 名 (15.4%) 发生重要肾脏不良事件(边际比数比,0.91; 95% 可信限 [CI], 0.84 to 0.99; 条件比数比,0.90; 95% CI, 0.82 to 0.99; P=0.04)。


Among critically ill adults, the use of balanced crystalloids for intravenous fluid administration resulted in a lower rate of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SMART-MED and SMART-SURG ClinicalTrials.gov numbers, NCT02444988 and NCT02547779.)



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