Effect of sodium bicarbonate ringer's solution on early renal function and prognosis of patients with traumatic brain injury after surgery: A single-center randomized controlled clinical study.

Abstract / Summary

Sodium bicarbonate ringer's solution is a novel crystalloid fluid that can effectively replenish circulating blood volume, improve renal blood perfusion, and maintain the body's acid-base homeostasis. The objective of this study was to compare the effects of sodium bicarbonate ringer's solution and lactate ringer's solution on early postoperative renal function and prognosis in patients with traumatic brain injury (TBI). A single-center, randomized, parallel controlled clinical study. General Hospital of Northern Theater Command. We recruited 124 TBI patients and intended to conduct emergency open craniocerebral surgery from June 2025 to December 2025. Patients were randomly assigned to two groups (n = 62 each): SBRS group and LRS group (administer fluid replacement with Sodium bicarbonate ringer's solution. and Lactated ringer's solution respectively). The primary outcome was creatinine clearance rate(Ccr) at 3 days after surgery. Secondary outcomes encompassed blood lactate (Lac), serum potassium (K+), oxygenation index (OI), and base excess (BE) at the time of entering the operating room (T0), after induction (T1),at the end of surgery (T2),at 12 h after the end of surgery (T3).Clinical outcome assessment included duration of mechanical ventilation,length of ICU stay,total length of hospital stay,incidence of acute kidney injury (AKI),improvement rate of short-term prognosis. Compared with the LRS group (77.4 ± 7.3 mL/min), the SBRS group (79.7 ± 8.7 mL/min) had a statistically significant difference in Ccr at postoperative day 3, with a least squares mean difference of -2.36 (95% CI: -4.13, -0.59; P = 0.010). In addition, the SBRS group also demonstrated significant differences at postoperative day 1 and day 2 (79.8 ± 9.7,79.9 ± 9.6 mL/min vs 76.0 ± 9.0,75.6 ± 7.5 mL/min), with corresponding least squares mean differences of -3.88 (95% CI: -5.37, -2.40; P < 0.001) and - 4.34 (95% CI: -5.89, -2.79; P < 0.001), respectively.From T2 to T3, Lac in the LRS group (1.7 ± 0.7, 2.0 ± 0.6 mmol/L) were significantly higher than that in the SBRS group (1.5 ± 0.7, 1.6 ± 0.7 mmol/L), with corresponding least squares mean differences of 0.30 (95% CI: 0.05, 0.55; P = 0.039) and 0.38 (95% CI: 0.13, 0.62; P = 0.003), respectively. At T2, K+ in the LRS group (3.58 ± 0.52 mmol/L) was significantly higher than that in the SBRS group (3.52 ± 0.50 mmol/L), with least squares mean differences of 0.14 (95% CI: 0.04, 0.24; P = 0.011).Other outcomes didn't show statistical differences. Compared with Lactated ringer's solution, Sodium bicarbonate ringer's solution used for perioperative fluid therapy in patients with TBI can better promote the early recovery of postoperative renal function, and this solution can significantly reduce blood lactate levels,yet this advantage does not translate into a significant impact on patients' postoperative clinical outcomes. This study therefore provides new evidence for fluid selection in perioperative volume therapy for TBI patients, however, the level of supporting evidence is limited, and further research in larger-scale multicenter trials is warranted. www.chictr.org.cn (Registration number ChiCTR2500102850, Registration date May 21, 2025).

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