Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, South Africa.
S Afr Med J. 2013 Apr 29;103(6):365-7. doi: 10.7196/samj.6969.
Recent trials have failed to demonstrate a survival benefit from the use of hydroxyethyl starches (HES) as a colloid in fluid resuscitation and have raised concerns of renal harm. In severe sepsis, there is a concerning signal of increased mortality. New high-quality systematic reviews consistently demonstrate a statistically non-significant relative risk of death of 1.08 - 1.10 and a significant 25% increased chance of requiring renal replacement therapy. The HES literature contains many industry-affiliated reviews of indifferent quality. Traditional efficacy confidence limits may warrant re-evaluation when considering these harms. Newer formulations of HES and more focused indications for use show benefit on surrogate endpoints, but these trials are currently underpowered to ensure safety.
最近的试验未能证明羟乙基淀粉（HES）作为胶体在液体复苏中的使用有生存获益，并引起了对肾脏损害的关注。在严重脓毒症中，死亡率增加的信号令人担忧。新的高质量系统评价一致显示，死亡的相对风险没有统计学意义，为 1.08-1.10，而需要肾脏替代治疗的几率显著增加 25%。HES 文献中包含许多质量一般的行业相关综述。在考虑这些危害时，传统的疗效置信区间可能需要重新评估。HES 的新型制剂和更有针对性的适应证在替代终点上显示出获益，但这些试验目前的效力不足以确保安全性。
