Allen Casey J, Ruiz Xiomara D, Meizoso Jonathan P, Ray Juliet J, Livingstone Alan S, Schulman Carl I, Namias Nicholas, Proctor Kenneth G
Divisions of Trauma and Surgical Critical Care, DeWitt Daughtry Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, 1800 Northwest 10th Avenue, Miami, FL 33136.
Mil Med. 2016 May;181(5 Suppl):152-5. doi: 10.7205/MILMED-D-15-00132.
For logistic reasons, a bolus of 6% hydroxyethyl starch (HES 450/0.7 in lactated electrolyte injection) is recommended for battlefield resuscitation even though it has risks of mortality and acute kidney injury (AKI) in certain patient populations. The purpose of this study was to test the hypothesis that victims of penetrating trauma have no increased risks of AKI and/or death when receiving a single bolus of HES during initial fluid resuscitation.
816 consecutive admissions with penetrating trauma were reviewed. Patients who died within 24 hours were excluded. Propensity scores and a 1:1 fixed ratio nearest neighbor matching were used to compare those who received HES to those who did not. Data were expressed as mean ± SD and significance was assessed at p < 0.05.
The cohort was 88% male, age 35 ± 14 years, injury severity score of 10 ± 10, with a 3.8% rate of AKI, and 3.2% rate of mortality. HES was administered to 121 (14.8%) patients. In HES and no HES propensity matched groups, the rate of AKI was 3.8% vs. 4.8% (p = 0.749) and the 90-day mortality rate was 3.8% vs. 4.8% (p = 0.749).
An increased risk of mortality or AKI was not observed in penetrating trauma patients who were resuscitated with low volume HES.
出于后勤方面的考虑，尽管6%羟乙基淀粉（乳酸电解质注射液中的HES 450/0.7）在某些患者群体中有导致死亡和急性肾损伤（AKI）的风险，但仍被推荐用于战场复苏。本研究的目的是检验以下假设：穿透性创伤受害者在初始液体复苏期间接受单次推注HES时，发生AKI和/或死亡的风险不会增加。
回顾了816例连续性穿透性创伤入院患者。排除24小时内死亡的患者。使用倾向评分和1:1固定比例最近邻匹配法比较接受HES的患者和未接受HES的患者。数据以均值±标准差表示，显著性以p<0.05评估。
该队列中88%为男性，年龄35±14岁，损伤严重程度评分为10±10，AKI发生率为3.8%，死亡率为3.2%。121例（14.8%）患者接受了HES治疗。在HES组和未接受HES的倾向匹配组中，AKI发生率分别为3.8%和4.8%（p=0.749），90天死亡率分别为3.8%和4.8%（p=0.749）。
在接受小剂量HES复苏的穿透性创伤患者中，未观察到死亡率或AKI风险增加。
