The Efficacy of Sodium Bicarbonate Ringer's Solution and Lactate Ringer's Solution in Patients Undergoing Long-Term Abdominal Open Surgery: A Multicenter Prospective Randomized Controlled Study.

Purpose: Sodium bicarbonate Ringer's solution (BRS) is an intravenous fluid that does not rely on hepatic or renal metabolism. It contains bicarbonate ions (HCO ) and lacks lactate ions. This study hypothesizes that BRS is more effective in maintaining acid-base balance during prolonged open abdominal surgeries. The aim is to investigate the effects of sodium bicarbonate Ringer's solution on lactate metabolism, acid-base balance, and clinical outcomes in patients undergoing extended-duration open abdominal surgery, with the objective of refining fluid replacement strategies for this patient population.

Patients And Methods: A multicenter randomized controlled trial was conducted involving 112 patients undergoing open abdominal surgery. Participants were randomly assigned to either the BRS group (n=55) or the lactated Ringer's solution (LRS) group (n=57). The primary outcome was the incidence of postoperative hyperlactacidemia, while secondary outcomes included serum lactate (Lac), pH, base excess (BE), buffered base (BB), bicarbonate (HCO ), blood glucose (Glu), electrolytes, postoperative liver and kidney function, and postoperative complications. Linear regression analysis was performed to identify factors influencing lactate concentration.

Results: The incidence of hyperlactic acidemia was lower in Group A compared to Group B (9.1% vs 19.3%, = 0.177), although the difference did not reach statistical significance. No significant differences were observed in lactate (Lac), pH, base excess (BE), bicarbonate (BB), HCO₃⁻, glucose (Glu), or electrolytes between the two groups at any time point ( < 0.001, > 0.05, > 0.05). Linear regression analysis revealed that diabetes, hypotension and blood loss were significant factors influencing blood lactate concentration = 0.349, < 0.001).

Conclusion: Sodium bicarbonate Ringer's solution and lactate Ringer's solution are both safe options for fluid replacement during long-term open abdominal surgeries. There is no significant difference observed in perioperative lactate levels, acid-base balance, or clinical postoperative outcomes between the two solutions.