蛛网膜下腔出血后用于扩容的羟乙基淀粉与肾功能：一项回顾性分析结果
Hydroxyethyl starch for volume expansion after subarachnoid haemorrhage and renal function: Results of a retrospective analysis.
作者信息
Bercker Sven, Winkelmann Tanja, Busch Thilo, Laudi Sven, Lindner Dirk, Meixensberger Jürgen
机构信息
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany.
Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
出版信息
PLoS One. 2018 Feb 15;13(2):e0192832. doi: 10.1371/journal.pone.0192832. eCollection 2018.
BACKGROUND
Hydroxyethyl starch (HES) was part of "triple-H" therapy for prophylaxis and therapy of vasospasm in patients with subarachnoid haemorrhage (SAH). The European Medicines Agency restricted the use of HES in 2013 due to an increase of renal failure in critically ill patients receiving HES compared to crystalloid fluids. The occurrence of renal insufficiency in patients with SAH due to HES is still uncertain. The purpose of our study was to evaluate whether there was an association with renal impairment in patients receiving HES after subarachnoid haemorrhage.
METHODS
Medical records of all non-traumatic SAH patients treated at the Departments of Anaesthesiology and Neurosurgery, University Hospital of Leipzig, Germany, between January 2009 and December 2014 were analysed. Patients received either HES 6% and/or 10% (HES group, n = 183) or exclusively crystalloids for fluid therapy (Crystalloid group, n = 93). Primary outcome was the incidence of acute kidney injury.
RESULTS
The study groups had similar characteristics except for initial SAPS scores, incidence of vasospasm and ICU length of stay. Patients receiving HES fulfilled significantly more often SIRS (systemic inflammatory response syndrome) criteria. 24.6% (45/183) of the patients in the HES group had acute kidney injury (KDIGO 1-3) at any time during their ICU stay compared to 26.9% (25/93) in the crystalloid group (p = 0.679). Only few patients needed renal replacement therapy with no significant difference between groups (Crystalloid group: 4.3%; HES group: 2.2%; p = 0.322). The incidence of vasospasm was increased in the HES group when compared to the crystalloid group (33.9% vs. 17.2%; p = 0.004).
CONCLUSION
In the presented series of patients with non-traumatic SAH we found no significant association between HES therapy and the incidence of acute kidney injury. Treatment without HES did not worsen patient outcome.
背景
羟乙基淀粉（HES）曾是蛛网膜下腔出血（SAH）患者预防和治疗血管痉挛的“三高”疗法的一部分。2013年，欧洲药品管理局限制了HES的使用，原因是与晶体液相比，接受HES治疗的重症患者肾衰竭发生率增加。HES导致SAH患者发生肾功能不全的情况仍不确定。我们研究的目的是评估蛛网膜下腔出血后接受HES治疗的患者是否与肾功能损害有关。
方法
分析了2009年1月至2014年12月期间在德国莱比锡大学医院麻醉科和神经外科治疗的所有非创伤性SAH患者的病历。患者接受6%和/或10%的HES（HES组，n = 183）或仅接受晶体液进行液体治疗（晶体液组，n = 93）。主要结局是急性肾损伤的发生率。
结果
除初始简化急性生理学评分（SAPS）、血管痉挛发生率和重症监护病房（ICU）住院时间外，研究组具有相似的特征。接受HES治疗的患者更常符合全身炎症反应综合征（SIRS）标准。HES组24.6%（45/183）的患者在ICU住院期间的任何时间发生急性肾损伤（KDIGO 1 - 3级），而晶体液组为26.9%（25/93）（p = 0.679）。只有少数患者需要肾脏替代治疗，两组之间无显著差异（晶体液组：4.3%；HES组：2.2%；p = 0.322）。与晶体液组相比，HES组血管痉挛的发生率增加（33.9%对17.2%；p = 0.004）。
结论
在本系列非创伤性SAH患者中，我们发现HES治疗与急性肾损伤的发生率之间无显著关联。不使用HES治疗并未使患者预后恶化。
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