Department of Anaesthesia, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, Western Cape 7925, South Africa.
Br J Anaesth. 2011 Nov;107(5):693-702. doi: 10.1093/bja/aer229. Epub 2011 Aug 19.
The role of fluids in trauma resuscitation is controversial. We compared resuscitation with 0.9% saline vs hydroxyethyl starch, HES 130/0.4, in severe trauma with respect to resuscitation, fluid volume, gastrointestinal recovery, renal function, and blood product requirements.
Randomized, controlled, double-blind study of severely injured patients requiring >3 litres of fluid resuscitation. Blunt and penetrating trauma were randomized separately. Patients were followed up for 30 days.
A total of 115 patients were randomized; of which, 109 were studied. For patients with penetrating trauma (n=67), the mean (sd) fluid requirements were 5.1 (2.7) litres in the HES group and 7.4 (4.3) litres in the saline group (P<0.001). In blunt trauma (n=42), there was no difference in study fluid requirements, but the HES group required significantly more blood products [packed red blood cell volumes 2943 (1628) vs 1473 (1071) ml, P=0.005] and was more severely injured than the saline group (median injury severity score 29.5 vs 18; P=0.01). Haemodynamic data were similar, but, in the penetrating group, plasma lactate concentrations were lower over the first 4 h (P=0.029) and on day 1 with HES than with saline [2.1 (1.4) vs 3.2 (2.2) mmol litre⁻¹; P=0.017]. There was no difference between any groups in time to recovery of bowel function or mortality. In penetrating trauma, renal injury occurred more frequently in the saline group than the HES group (16% vs 0%; P=0.018). In penetrating trauma, maximum sequential organ function scores were lower with HES than with saline (median 2.4 vs 4.5, P=0.012). No differences were seen in safety measures in the blunt trauma patients.
In penetrating trauma, HES provided significantly better lactate clearance and less renal injury than saline. No firm conclusions could be drawn for blunt trauma.
ISRCTN 42061860.
在创伤复苏中，液体的作用存在争议。我们比较了 0.9%生理盐水与羟乙基淀粉（HES 130/0.4）在严重创伤患者中的复苏效果、液体量、胃肠道恢复情况、肾功能和血液制品需求。
对需要>3 升液体复苏的严重创伤患者进行随机、对照、双盲研究。钝性和穿透性创伤分别随机分组。患者随访 30 天。
共随机分配了 115 名患者，其中 109 名进行了研究。对于穿透性创伤患者（n=67），HES 组的平均（标准差）液体需求为 5.1（2.7）升，生理盐水组为 7.4（4.3）升（P<0.001）。在钝性创伤患者（n=42）中，两组的研究液体需求没有差异，但 HES 组需要更多的血液制品[浓缩红细胞体积 2943（1628）比 1473（1071）ml，P=0.005]，且损伤严重程度评分高于生理盐水组（中位数 29.5 比 18；P=0.01）。血流动力学数据相似，但在穿透组中，HES 组在最初 4 小时（P=0.029）和第 1 天的血浆乳酸浓度更低[2.1（1.4）比 3.2（2.2）mmol/L；P=0.017]。各组之间肠道功能恢复时间或死亡率均无差异。在穿透性创伤中，生理盐水组的肾功能损伤发生率高于 HES 组（16%比 0%；P=0.018）。在穿透性创伤中，HES 组的序贯器官功能衰竭评分低于生理盐水组（中位数 2.4 比 4.5，P=0.012）。钝性创伤患者的安全性指标无差异。
在穿透性创伤中，HES 比生理盐水提供了更好的乳酸清除率和更少的肾损伤。钝性创伤尚无明确结论。
ISRCTN42061860。
