Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Curr Opin Crit Care. 2013 Aug;19(4):321-5. doi: 10.1097/MCC.0b013e3283632de6.
Resuscitation with hydroxyethyl starch (HES) is controversial. In this review, we will present the current evidence for the use of HES solutions including data from recent high-quality randomized clinical trials.
Meta-analyses of HES vs. control fluids show clear signals of harm including adverse effects on kidney and haemostatic function, and trends towards increased mortality. These results are mainly based on recent large randomized clinical trials comparing tetrastarch (HES 130/0.4 and HES 130/0.42) vs. crystalloid in patients in the ICU. Trials in trauma and surgical patients cannot adequately assess safety issues and do not show clear benefit with the use of HES. There is currently no firm evidence that tetrastarch has better safety profile than the former HES solutions.
There is no evidence for an overall beneficial effect of HES in any subgroup of critically ill patients, but there are clear signs of harm. As safer alternatives exist, we recommend that HES is no longer used in critically ill patients.
羟乙基淀粉（HES）的复苏作用存在争议。在本综述中，我们将介绍 HES 溶液的最新证据，包括来自最近高质量随机临床试验的数据。
HES 与对照液相比的荟萃分析显示出明确的危害信号，包括对肾脏和止血功能的不良影响，以及死亡率增加的趋势。这些结果主要基于最近在 ICU 患者中比较四明胶（HES 130/0.4 和 HES 130/0.42）与晶体液的大型随机临床试验。创伤和手术患者的试验不能充分评估安全性问题，并且使用 HES 没有显示出明确的益处。目前没有确凿的证据表明四明胶比以前的 HES 溶液具有更好的安全性。
在任何亚组危重症患者中，HES 均无总体有益作用的证据，但存在明确的危害信号。由于存在更安全的替代方案，我们建议不再在危重症患者中使用 HES。
