Department of Anaesthetics and Intensive Care, Chelsea and Westminster Hospital, London SW10 9NH, UK.
Crit Care. 2012 Feb 16;16(1):110. doi: 10.1186/cc11155.
Hydroxyethylstarch (HES) 200/0.5 is associated with renal failure. Several studies have suggested that renal function is affected but the subsequent arguments leave the clinician in no man's land. A recent study in Critical Care by Simon and colleagues using a two hit animal model of shock demonstrates that the use of a higher molecular weight starch, HES 200/0.5, is associated with impaired renal function when compared with ringers acetate, gelatin or a lower molecular weight starch, HES 130/0.42. The authors conclude that both the lower molecular weight starch and the ringers acetate 'preserve renal function and attenuate tubular damage better than 10% hydroxyethylstarch 200/0.5 in saline'. Added to the previous evidence, the renal effects of HES200/0.5 are probably real. Many clinicians have already moved to the lower molecular weight starches on the basis of doubt rather than certainty, but this study tips the balance. The cause remains elusive and the lack of a mechanism should be seen as a problem.
羟乙基淀粉（HES）200/0.5 与肾衰竭有关。多项研究表明肾功能受到影响，但随后的争论使临床医生陷入困境。最近西蒙等人在《危重病医学》上发表的一项使用休克双打击动物模型的研究表明，与醋酸林格氏液、明胶或低分子质量淀粉 HES 130/0.42 相比，使用高分子质量淀粉 HES 200/0.5 与肾功能受损有关。作者得出结论，低分子质量淀粉和醋酸林格氏液“在生理盐水方面比 10%羟乙基淀粉 200/0.5 更好地保留肾功能并减轻肾小管损伤”。加上之前的证据，HES200/0.5 的肾脏作用可能是真实的。许多临床医生已经基于怀疑而不是确定转向低分子质量淀粉，但这项研究改变了平衡。病因仍然难以捉摸，缺乏机制应被视为一个问题。
