Critical Care Medicine, The George Institute for Global Health, St George Clinical School, University of New South Wales, Sydney, Australia.
Intensive Care Med. 2013 Jun;39(6):998-1001. doi: 10.1007/s00134-013-2890-3. Epub 2013 Apr 5.
Recent high-quality randomised-controlled trials comparing the effects of hydroxyethyl starch (HES) preparations and crystalloids for fluid resuscitation in critically ill patients have demonstrated an increased risk of death and use of renal replacement therapy (RRT). Consequently, a number of systematic reviews incorporating these new results have been published that have consistently demonstrated an increased risk of death and use of RRT associated with HES solutions, regardless of type of HES and dose administered, both in general intensive care patients and in those with severe sepsis. These effects become apparent in the post-resuscitation period and may relate to increased tissue accumulation associated with HES. These results question the clinical role of semi-synthetic colloids for fluid resuscitation and mandate a reappraisal about how these fluids are administered to critically ill patients, specifically considering the potential for toxicity.
最近的高质量随机对照试验比较了羟乙基淀粉（HES）制剂和晶体液在危重病患者液体复苏中的作用，结果表明 HES 制剂增加了死亡和使用肾脏替代治疗（RRT）的风险。因此，已经发表了许多纳入这些新结果的系统评价，这些评价一致表明，无论 HES 类型和给予的剂量如何，HES 溶液与死亡和 RRT 的使用风险增加相关，无论是在一般重症监护患者还是严重脓毒症患者中。这些影响在复苏后时期变得明显，可能与 HES 相关的组织积累增加有关。这些结果质疑了半合成胶体在液体复苏中的临床作用，并要求重新评估如何向危重病患者给予这些液体，特别是要考虑到潜在的毒性。
