危重病人术中输注生理盐水还是乳酸林格氏溶液？
Infusion of large volumes of saline solution can cause hyperchloremic metabolic acidosis. 输注大量生理盐水可引起高氯性代谢性酸中毒Lactated Ringer’s solution contains less chloride, reducing the risk of hyperchloremic metabolic acidosis. 乳酸林格氏溶液含氯化物较少，减少高氯酸盐代谢性酸中毒的风险The hypothesis that a composite of in-hospital mortality and major postoperative complications would be lower in patients administered lactated Ringer’s solution than in those administered saline solution was tested in patients having colorectal or orthopedic surgery.假设结直肠或矫形外科手术患者中乳酸林格液组住院死亡率和主要术后并发症低于生理盐水使用组的患者。
In an alternating cohort controlled trial, 4,187 (49%) patients were assigned to receive lactated Ringer’s solution and 4,429 (51%) were assigned to receive normal saline solution. Patients were given a median of nearly 2 l of lactated Ringer’s or saline solution in less than 4 h. 在一项交替队列对照试验中，4,187例（49%)患者被分配接受乳酸林格液组，4,429例(51%）被分配接受生理盐水组。在不到4小时内 患者 使用乳酸林格氏液或盐水溶液的中位数为近2l。
The primary composite of in-hospital mortality and major complications (moderate or severe acute kidney injury, infections, respiratory complications, and hemorrhage) was observed in 5.8% of lactated Ringer’s and 6.1% of normal saline patients (absolute difference –0.3%; 95% CI, –1.3% to 0.7%).我们观察到5.8%乳酸林格氏液组和6.1%的生理盐水组患者（中度或重度急性肾损伤、感染、呼吸道并发症和出血）住院死亡率和主要并发症的主要综合因素 Using an intent-to-treat approach, the estimated average relative risk of lactated Ringer’s versus saline solution across the individual components was 1.16 (95% CI, 0.89 to 1.52). 采用意向治疗（目标导向治疗）方法，乳酸林格氏相比于生理盐水平均相对风险低（1.16倍）(95% CI, 0.89 to 1.52)SeetheaccompanyingEditorialonpage609.(Summary:M.J.Avram.Image:S.M.Jarret,M.F.A.,C.M.I./J.P.Rathmell.)
Cannabis Use Disorder and Perioperative Outcomes in Major Elective Surgeries: A Retrospective Cohort Analysis
大麻使用障碍和择期手术围手术期手术的结果：回顾性队列分析
Surgical patients with an active cannabis use disorder may be at an increased risk of adverse outcomes given the potential for psychoactive and hemodynamic effects within the perioperative setting. 有持续性大麻使用障碍的外科患者因为在围手术期可能会产生精神和血流动力学效应而产生不良后果的风险。 A retrospective cohort study was conducted to test the hypothesis that nonambulatory surgery patients with an active cannabis use disorder have a higher risk of postoperative complications using data obtained from the Nationwide Inpatient Sample from 2006 to 2015. 从2006年至2015年获得的全国住院样本中进行了一项回顾性队列研究，以检验非卧床手术患者有活动性大麻使用障碍术后并发症更高风险的假设 The primary composite outcome consisted of clinically relevant postoperative complications, including myocardial infarction, stroke, sepsis, deep vein thrombosis/pulmonary embolus, acute kidney injury requiring dialysis, respiratory failure, and in-hospital mortality.主要综合结果包括临床相关的术后并发症，包括心肌梗死、中风、脓毒症、深静脉血栓形成/肺栓塞、急性肾损伤 需要透析、呼吸衰竭和住院死亡率。 A propensity score matched-pairs analysis of the cohort was used to evaluate the adjusted association between active cannabis use disorders and the outcome of interest; the matched-pairs cohort consisted of 13,603 patients in each group. 使用倾向性得分配对分析来评估活跃的大麻使用障碍与临床结果之间关联；配对队列每组13603例。 There was no statistically significant difference in the composite perioperative outcome between patients with (400 of 13,603; 2.9%) and without (415 of 13,603; 3.1%) a reported active cannabis use disorder (adjusted odds ratio 0.97; 95% CI, 0.84 to 1.11). 报告的大麻使用活跃的患者（13,603例中有400例；2.9%)和未报告的(13,603例中有415例；3.1%）的综合围手术期结果无统计学差异 等序(调整优势比0.97；95%CI，0.84至1.11)。 See theaccompanying Editorial on page 612. (Summary: M. J. Avram. Image: Adobe Stock.)
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