Sánchez-Sánchez M, Garcia-de-Lorenzo A, Cachafeiro L, Herrero E, Asensio M J, Agrifoglio A, Flores E, Estebanez B, Extremera P, Iglesias C, Martinez J R
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
Department of Plastic Surgery, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
Ann Burns Fire Disasters. 2016 Sep 30;29(3):183-188.
Acute kidney injury (AKI) is an important complication in burn patients. Recently, it has been recommended that hydroxyethyl starch (HES) be avoided in burn patients because it increases the incidence of AKI. Our purpose was to study incidence of AKI in critically ill burn patients resuscitated with Ringer's solution and supplements of HES. We conducted an observational study of 165 patients admitted to the critical care burn unit (with 30 ± 15% TBSA burned). The main outcome measures were incidence of AKI, contributions of colloids and crystalloids, various severity scores, comorbidities, complications and mortality. According to the RIFLE criteria, 10 (6.1%) patients presented with Risk, 11 (6.7%) presented with Injury and 11 (6.7%) presented with Failure. According to the AKIN criteria, 9.7% presented stage I, 3% stage II and 10.3% stage III. Replacement therapy (RRT) was performed in 15 patients (9.1%), but in 6 of them RRT was employed in the final stages of multi-organ failure. The incidence of AKI in severe burn patients is high according to the RIFLE or AKIN criteria and these patients experience more complications and higher mortality. Our study suggests that the use of HES in low doses in the burn resuscitation phase does not cause more AKI than resuscitation without HES, but further evaluation is required. Further studies should be conducted.
急性肾损伤（AKI）是烧伤患者的一种重要并发症。最近，有人建议烧伤患者应避免使用羟乙基淀粉（HES），因为它会增加AKI的发生率。我们的目的是研究在使用林格氏液和补充HES进行复苏的重症烧伤患者中AKI的发生率。我们对165名入住重症烧伤监护病房（烧伤面积为30±15%TBSA）的患者进行了一项观察性研究。主要观察指标为AKI的发生率、胶体和晶体的贡献、各种严重程度评分、合并症、并发症和死亡率。根据RIFLE标准，10名（6.1%）患者出现风险期，11名（6.7%）出现损伤期，11名（6.7%）出现衰竭期。根据AKIN标准，9.7%为I期，3%为II期，10.3%为III期。15名患者（9.1%）接受了肾脏替代治疗（RRT），但其中6名患者是在多器官功能衰竭的最后阶段接受RRT的。根据RIFLE或AKIN标准，重度烧伤患者的AKI发生率很高，这些患者会经历更多并发症和更高的死亡率。我们的研究表明，在烧伤复苏阶段低剂量使用HES不会比不使用HES导致更多的AKI，但需要进一步评估。应进行进一步的研究。
