Порівняння ефективності рідинної ресусцитації хворих із септичним шоком розчинами рінгер-малат та ізотонічним розчином натрію хлориду

Abstract

One of the key elements of therapy for sepsis and septic shock is the fluid replacement. Current guidelines suggests an insfusion of at least 30 ml / kg of crystalloid in the first three hours, and if necessary, more. Preference is given to balanced crystalloid solutions, but the choice of a particular solution remains unclear. A randomized, controlled study of the “Ringer-Malat” balanced crystalloid solution was performed, compared with isotonic saline for primary resuscitation of septic shock patients. The study involved 48 patients randomized to ringer malate (experimental) and 0.9% sodium chloride (control) group. The 30-day mortality rate was not significantly different between the groups (20.0% and 21.4% respectively, p = 0.521), but the trend was noted for less time on vasopressor support (58.2 versus 74.3 hours, respectively, p = 0.072), higher delivery of oxygen (1064.26 vs. 612.38 ml / min, p <0.001), greater clearance of lactate (22.14% vs. 16.28% p <0.001). In the Ringer Malate group, no cases of hyperchloremic acidosis were noted, and in the control group there were 3 cases (13.04%). Thus, the use of balanced crystalloids (in particular, Ringer Malat) allows for better results in the treatment of septic shock compared with isotonic sodium chloride solution, although additional studies on a larger scale are needed to determine the effect on mortality.