羟乙基淀粉与明胶用于创伤复苏的随机试验。

Randomized trial of hydroxyethyl starch versus gelatine for trauma resuscitation.

作者信息

Allison K P, Gosling P, Jones S, Pallister I, Porter K M

机构信息

West Midlands Regional Training Scheme, UK.

出版信息

J Trauma. 1999 Dec;47(6):1114-21. doi: 10.1097/00005373-199912000-00023.

DOI:10.1097/00005373-199912000-00023

PMID:10608543

Abstract

BACKGROUND

Previous studies have demonstrated the rapid increase in systemic capillary permeability after blunt trauma and its association with poor outcome. There are theoretical advantages in resuscitation with colloid fluids, which are well retained in the vascular compartment during times of capillary leak. The aim of this study was to compare the effects of posttrauma resuscitation with hydroxyethyl starch (HES) (molecular mass, 250 kDa) or gelatine (molecular mass, 30 kDa), the hypothesis being that HES would reduce capillary leak.

METHODS

Forty-five patients suffering blunt trauma were randomized on admission to receive either gelatine (Gelofusine) (n = 21) or HES (Pentaspan) (n = 24) for the first 24 hours, after which the choice of fluid was at the discretion of the clinician. The mean Injury Severity Score for the HES and gelatine groups were 20.0 (range, 9-41) and 18.1 (range, 9-32), respectively (p = 0.43). Capillary permeability was assessed by urine albumin excretion rate for the first 24 hours. For 5 days the daily mean P(O2)/F(IO2) ratio, serum C-reactive protein, hemoglobin, white cell and platelet counts, prothrombin, and activated partial thromboplastin time were recorded.

RESULTS

Capillary permeability was lower in HES-treated patients during the first 24 hours. Log mean (95% confidence interval) albumin excretion rate for gelatine and HES groups at 6 hours were 117.5 (84.9) and 46.8 (24.3) microg/min (p = 0.011), at 12 hours were 54.9 (30.0) and 17.2 (7.6) microg/min (p = 0.001), and at 24 hours were 50.5 (23.4) and 23.6 (16.3) microg/min (p = 0.030), respectively. The mean (95% confidence interval) P(O2)/F(IO2) ratio for the HES and gelatine groups 48 hours after admission were 324 (44) and 267 (43) mm Hg, respectively (p = 0.03). The mean (95% confidence interval) serum C-reactive protein in the HES and gelatine groups 24 hours after admission were 72.4 (19.2) and 105.7 (30.1) mg/L, respectively (p = 0.03). There were no significant differences in any of the hematologic parameters during the first 48 hours.

CONCLUSION

The results suggest that compared with gelatine, resuscitation with HES reduces posttrauma capillary leak.

摘要

背景

先前的研究已证明钝性创伤后全身毛细血管通透性迅速增加，且与不良预后相关。胶体液复苏具有理论优势，在毛细血管渗漏时能很好地保留在血管腔内。本研究的目的是比较创伤后用羟乙基淀粉（HES）（分子量250 kDa）或明胶（分子量30 kDa）进行复苏的效果，假设是HES会减少毛细血管渗漏。

方法

45例钝性创伤患者入院时随机分组，在前24小时接受明胶（佳乐施）（n = 21）或HES（万汶）（n = 24）治疗，之后液体的选择由临床医生决定。HES组和明胶组的平均损伤严重度评分分别为20.0（范围9 - 41）和18.1（范围9 - 32）（p = 0.43）。通过最初24小时的尿白蛋白排泄率评估毛细血管通透性。连续5天记录每日平均P（O2）/F（IO2）比值、血清C反应蛋白、血红蛋白、白细胞和血小板计数、凝血酶原及活化部分凝血活酶时间。

结果

HES治疗的患者在最初24小时内毛细血管通透性较低。明胶组和HES组在6小时时的对数平均（95%置信区间）白蛋白排泄率分别为117.5（84.9）和46.8（24.3）μg/min（p = 0.011），12小时时分别为54.9（30.0）和17.2（7.6）μg/min（p = 0.001），24小时时分别为50.5（23.4）和23.6（16.3）μg/min（p = 0.030）。入院48小时后，HES组和明胶组的平均（95%置信区间）P（O2）/F（IO2）比值分别为324（44）和267（43）mmHg（p = 0.03）。入院24小时后，HES组和明胶组的平均（95%置信区间）血清C反应蛋白分别为72.4（19.2）和105.7（30.1）mg/L（p = 0.03）。在最初48小时内，各项血液学参数均无显著差异。