Département d'Anesthésie et de Réanimation, CHU Nord, Assistance Publique-Hôpitaux de Marseille, Marseille cedex, France.
Anesthesiology. 2013 Feb;118(2):387-94. doi: 10.1097/ALN.0b013e31827e5569.
The aim of this meta-analysis was to evaluate renal safety with the active substance of the latest generation of waxy maize-derived hydroxyethyl starch in surgical patients. The authors focused on prospective, randomized, controlled studies that documented clinically relevant variables with regard to renal effects of waxy maize-derived hydroxyethyl starch 130/0.40.
The authors carefully searched for all available prospective, randomized studies and evaluated the greatest delta from baseline values in renal safety variables (serum creatinine values, calculated creatinine clearance, incidence of renal replacement therapy, and acute renal failure). The authors included 17 studies that analyzed patients (n = 1,230) undergoing a variety of surgical procedures.
For maximum serum creatinine values, the effect size estimate was 0.068 (95% CI = -0.227 to 0.362), P = 0.65. For calculated creatinine clearance values, pooled risk difference was 0.302 (95% CI = -0.098 to 0.703), P = 0.14. For incidence of acute renal failure, pooled risk difference was 0.0003 (95% CI = -0.018 to 0.019), P = 0.98. For incidence of renal replacement therapy, pooled risk difference was -0.003 (95% CI = -0.028 to 0.022), P = 0.85.
The authors found no evidence for renal dysfunction caused by modern waxy maize-derived hydroxyethyl starch 130/0.40 in surgical patients.
本荟萃分析旨在评估最新一代蜡质玉米衍生羟乙基淀粉活性物质在外科患者中的肾脏安全性。作者重点关注前瞻性、随机、对照研究,记录与蜡质玉米衍生羟乙基淀粉 130/0.40 的肾脏效应相关的临床相关变量。
作者仔细搜索了所有可用的前瞻性、随机研究,并评估了肾脏安全性变量(血清肌酐值、计算肌酐清除率、肾脏替代治疗发生率和急性肾衰竭)的最大基线值差值。作者纳入了 17 项分析接受各种手术的患者(n=1230)的研究。
对于最大血清肌酐值,效应量估计值为 0.068(95%置信区间=-0.227 至 0.362),P=0.65。对于计算的肌酐清除率值,汇总风险差为 0.302(95%置信区间=-0.098 至 0.703),P=0.14。对于急性肾衰竭的发生率,汇总风险差为 0.0003(95%置信区间=-0.018 至 0.019),P=0.98。对于肾脏替代治疗的发生率,汇总风险差为-0.003(95%置信区间=-0.028 至 0.022),P=0.85。
作者没有发现现代蜡质玉米衍生羟乙基淀粉 130/0.40 引起外科患者肾功能障碍的证据。