Abstract：
OBJECTIVE: Balanced crystalloid and normal saline are routinely used in clinical anesthesia, but their safety and efficacy in non-cardiac surgeries are still unclear.
METHODS: PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI, from January 1980 to March 2023, were searched. Studies comparing balanced crystalloid (BC) with normal saline (NS) during non-cardiac surgeries were included. The primary outcomes were clinical outcomes (acidosis, renal insufficiency, and mortality), and the secondary outcomes were pH value, Na+, Cl- and creatinine levels, and vasopressor requirement.
RESULTS: Forty-three RCTs were included in this meta-analysis. Low evidence revealed that the development of acidosis was lower in the BC group than in the NS group (OR: 0.05, 95% CI: 0.01-0.43, I2=80.8%, p=0.00), and no between-group difference exists in renal insufficiency and mortality. At the end of surgery and on postoperative day 1 (POD 1), the pH value was higher, and the levels of Na+ and Cl- were lower in the BC group. No between-group difference exists in creatinine level and vasopressor requirement.
CONCLUSIONS: Perioperative balanced crystalloids can maintain the stability of acid-base and electrolyte balance and reduce acidosis compared with saline, but they cannot reduce postoperative renal insufficiency and mortality.
METHODS: PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI, from January 1980 to March 2023, were searched. Studies comparing balanced crystalloid (BC) with normal saline (NS) during non-cardiac surgeries were included. The primary outcomes were clinical outcomes (acidosis, renal insufficiency, and mortality), and the secondary outcomes were pH value, Na+, Cl- and creatinine levels, and vasopressor requirement.
RESULTS: Forty-three RCTs were included in this meta-analysis. Low evidence revealed that the development of acidosis was lower in the BC group than in the NS group (OR: 0.05, 95% CI: 0.01-0.43, I2=80.8%, p=0.00), and no between-group difference exists in renal insufficiency and mortality. At the end of surgery and on postoperative day 1 (POD 1), the pH value was higher, and the levels of Na+ and Cl- were lower in the BC group. No between-group difference exists in creatinine level and vasopressor requirement.
CONCLUSIONS: Perioperative balanced crystalloids can maintain the stability of acid-base and electrolyte balance and reduce acidosis compared with saline, but they cannot reduce postoperative renal insufficiency and mortality.
摘要：
目的：临床麻醉常规使用平衡晶体和生理盐水，但其在非心脏手术中的安全性和有效性仍不清楚.
方法：PubMed，Embase,WebofScience,科克伦图书馆,万方,和CNKI，从1980年1月到2023年3月，进行了搜索。包括在非心脏手术期间比较平衡晶体（BC）与生理盐水（NS）的研究。主要结果是临床结果(酸中毒，肾功能不全,和死亡率），次要结果是pH值，Na+,Cl-和肌酐水平，和血管加压药的要求。
结果：本荟萃分析包括43个随机对照试验。低证据表明，BC组酸中毒的发展低于NS组（OR：0.05，95％CI：0.01-0.43，I2=80.8％，p=0.00),肾功能不全和死亡率无组间差异。在手术结束和术后第1天（POD1），pH值较高，BC组Na+和Cl-水平较低。肌酐水平和血管加压药需求无组间差异。
结论：与生理盐水相比，围手术期平衡晶体可以维持酸碱和电解质平衡的稳定，减少酸中毒。但不能降低术后肾功能不全和死亡率。
方法：PubMed，Embase,WebofScience,科克伦图书馆,万方,和CNKI，从1980年1月到2023年3月，进行了搜索。包括在非心脏手术期间比较平衡晶体（BC）与生理盐水（NS）的研究。主要结果是临床结果(酸中毒，肾功能不全,和死亡率），次要结果是pH值，Na+,Cl-和肌酐水平，和血管加压药的要求。
结果：本荟萃分析包括43个随机对照试验。低证据表明，BC组酸中毒的发展低于NS组（OR：0.05，95％CI：0.01-0.43，I2=80.8％，p=0.00),肾功能不全和死亡率无组间差异。在手术结束和术后第1天（POD1），pH值较高，BC组Na+和Cl-水平较低。肌酐水平和血管加压药需求无组间差异。
结论：与生理盐水相比，围手术期平衡晶体可以维持酸碱和电解质平衡的稳定，减少酸中毒。但不能降低术后肾功能不全和死亡率。
