We have read with great interest the article by Pfortmueller et al. about fluid management in patients undergoing cardiac surgery [1]. This randomized double blind study showed equivalence between Ringer’s lactate solution and Ringer’s acetate solution in terms of hemodynamic stability, as well as the acid-base and ionic profiles of the two patient populations. However, they observed a higher prevalence of postoperative cardiac arrhythmia in the group receiving Ringer’s lactate solution without a change in the pH or electrolyte values. Previous work has shown that acetate-based dialysate solutions cause hemodynamic and rhythmic disruption. Acetate induces the production of cyclic adenosine monophosphate (cAMP) and cytokines that increase the synthesis of nitric oxide (NO). Studies have shown that acetate-induced NO production induces hypotension during dialysis. Noris et al. showed that the levels of NO and interleukin (IL)-1β are higher after dialysis with acetate than after dialysis with bicarbonate. They suggested that acetate-activated monocytes produce Il-1β that in turn stimulates endothelial cells to produce NO, which can result in hemodynamic instability and arrhythmias [2]. Regarding acid-base balance, it has been shown that Ringer’s lactate solution has a strong ion difference (SID) of 28 while acetate-based solutions have a SID of around 36. Infusion of Ringer’s lactate solution results in a larger reduction in pH when compared to acetate solutions. In vivo, regardless of whether a lactateor acetatebased solution is infused, serum potassium levels do not change to a degree that could result in rhythm disturbances [3].

中文翻译：

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心脏手术期间输注醋酸林格氏液和乳酸林格氏液期间心律失常的机制：新见解

我们非常感兴趣地阅读了 Pfortmueller 等人的文章。关于接受心脏手术的患者的液体管理 [1]。这项随机双盲研究表明，林格氏乳酸盐溶液和林格氏乙酸盐溶液在血液动力学稳定性以及两个患者群体的酸碱和离子特征方面是等效的。然而，他们观察到在接受乳酸林格氏溶液而不改变 pH 值或电解质值的组中，术后心律失常的发生率更高。以前的工作表明，基于醋酸盐的透析液会导致血液动力学和节律紊乱。醋酸盐诱导环磷酸腺苷 (cAMP) 和增加一氧化氮 (NO) 合成的细胞因子的产生。研究表明，醋酸诱导的 NO 产生会在透析过程中引起低血压。诺里斯等人。表明用醋酸盐透析后 NO 和白细胞介素 (IL)-1β 的水平高于用碳酸氢盐透析后。他们认为醋酸激活的单核细胞会产生 Il-1β，进而刺激内皮细胞产生 NO，这会导致血流动力学不稳定和心律失常 [2]。关于酸碱平衡，已经表明林格氏乳酸盐溶液的强离子差 (SID) 为 28，而乙酸盐基溶液的 SID 约为 36。相比之下，林格氏乳酸盐溶液的输注导致 pH 值降低幅度更大到醋酸盐溶液。在体内，无论是否注入基于乳酸盐或醋酸盐的溶液，