手术中用羟乙基淀粉 130/0.4 或白蛋白进行容量替代后对肾功能的影响及死亡率：一项倾向评分匹配研究。

Postoperative renal morbidity and mortality after volume replacement with hydroxyethyl starch 130/0.4 or albumin during surgery: a propensity score-matched study.

机构信息

Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan.

Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.

出版信息

J Anesth. 2020 Dec;34(6):881-891. doi: 10.1007/s00540-020-02838-z. Epub 2020 Aug 11.

DOI:10.1007/s00540-020-02838-z

PMID:32783070

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7674565/

Abstract

PURPOSE

We aimed to compare retrospectively the rates of renal morbidity and mortality in surgical patients receiving 6% HES 130/0.4 to those receiving albumin.

METHODS

From a Japanese nationwide medical database between 2014 and 2016, we identified adults who received HES 130/0.4 (HES group) or albumin (albumin group) as a single colloid solution on the day of surgery. After propensity score matching, the two groups were analyzed with χ or Mann Whitney U test. The primary outcome was the incidence of acute kidney injury (AKI). Secondary outcomes included the incidence of renal-replacement therapy, hospital length of stay, in-hospital 30-day mortality, the use of vasoactive agents, and the fluid requirement on the day of surgery.

RESULTS

Of 76,048 patients in the database, propensity score matching identified 289 matched pairs. There was no statistically significant difference in the incidence of AKI between the HES and the albumin group (15.2% vs. 20.8%, respectively: P = 0.08). The secondary outcomes did not differ between groups except the following. Median hospital stay was 5 days shorter in the HES group (18 vs. 23 days; P < 0.001), and the median net fluid requirement on the day of surgery was 15 mL/kg lower in the HES group (140 vs. 155 mL/kg, respectively; P = 0.01).

CONCLUSIONS

Postoperative renal morbidity and mortality did not differ between patients receiving HES 130/0.4 and those receiving albumin. HES 130/0.4 was associated with shorter hospital stay and less fluid requirement compared to albumin. These findings support the use of 6% HES 130/0.4 for perioperative volume replacement as an alternative to albumin.

TRIAL REGISTRATION

UMIN000027896 and the date of registration was June 30, 2017 at https://www.umin.ac.jp/ctr/index-j.html .

摘要

目的

我们旨在回顾性比较接受 6%羟乙基淀粉 130/0.4 和白蛋白的手术患者的肾脏发病率和死亡率。

方法

我们从 2014 年至 2016 年的日本全国医疗数据库中，确定了在手术当天接受 HES 130/0.4（HES 组）或白蛋白（白蛋白组）作为单一胶体溶液的成年人。通过倾向评分匹配后，用 χ 或曼-惠特尼 U 检验分析两组。主要结局是急性肾损伤（AKI）的发生率。次要结局包括肾脏替代治疗、住院时间、住院 30 天死亡率、血管活性药物的使用以及手术当天的液体需求。

结果

在数据库中的 76048 名患者中，通过倾向评分匹配确定了 289 对匹配。HES 组和白蛋白组的 AKI 发生率无统计学差异（分别为 15.2%和 20.8%：P=0.08）。除以下几点外，两组的次要结局无差异。HES 组的中位住院时间短 5 天（18 天 vs. 23 天；P<0.001），HES 组手术当天的净液体需求中位数低 15 mL/kg（分别为 140 和 155 mL/kg；P=0.01）。