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J Neurosurg Anesthesiol:羟乙基淀粉液体治疗对SAH患者肾功能的影响

2015-08-30 MedSci MedSci原创

羟乙基淀粉(HES)是一种复方制剂,每100ml组分中含羟乙基淀粉130/0.4 6g和氯化钠0.9g,临床上主要用于血容量不足,急性等容血液稀释(ANH)的治疗和预防。然而,近期的报道对羟乙基淀粉用于容量复苏的有效性和安全性产生了怀疑。有报道称,羟乙基淀粉会促进肾功能不全的发生,特别是对于脓毒症和创伤患者来说。近日,德国维尔茨堡大学医院的研究人员,针对使用6%130/0.4羟乙基淀粉,

羟乙基淀粉(HES)是一种复方制剂,每100ml组分含羟乙基淀粉130/0.4 6g和氯化钠0.9g,临床上主要用于血容量不足,急性等容血液稀释(ANH)治疗和预防。然而,近期的报道对羟乙基淀粉用于容量复苏的有效性和安全性产生了怀疑。有报道称,羟乙基淀粉会促进肾功能不全的发生,特别是对于脓毒症和创伤患者来说。近日,德国维尔茨堡大学医院的研究人员,针对使用6%130/0.4羟乙基淀粉,对肾功能正常的动脉瘤性蛛网膜下腔出血(SAH)患者进行液体治疗的效果进行了评估。

此次回顾性分析共招募了107例蛛网膜下腔出血患者。由于镁是通过肾脏排泄的,本次研究由此对肾功能不全的患者进行了筛除。动脉瘤栓塞后的标准治疗包含每日 6% 130/0.4羟乙基淀粉的输注。同时,每日对血浆和尿中的肌酐及液体平衡进行监测。

患者每日平均输入了1101±524mL羟乙基淀粉和3353±1396mL林格式溶液。在入院的第三天,肌酐达到峰值(0.88±0.25mg/ 100 mL),随之即开始持续下降。其中有6位患者肌酐值暂时性的升高超过了0.3mg/100mL,但是在观察期的最后阶段又恢复到了入院时的水平。

 

就肾功能来说,蛛网膜下腔出血后的第一天似乎是一个“脆弱”的阶段,在这个阶段医生可能会对患者进行多种不同的干预措施,包括对比增强神经放射学过程。在此期间,6% 130/0.4羟乙基淀粉的输注需要格外注意。然而,并没有发现患者因此而出现肾功能不全,需要暂时或者永久肾脏代替治疗的情况。因此,研究人员认为输注 6% 130/0.4羟乙基淀粉对于先前没有肾功能不全的蛛网膜下腔出血患者是安全的。

原始出处:

Ekkehard Kunze,Christian Stetter,et al.Effects of Fluid Treatment With Hydroxyethyl Starch on Renal Function in Patients With Aneurysmal Subarachnoid Hemorrhage. J Neurosurg Anesthesiol. 2015 Jul 2.

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    2016-09-15 1e10c84am36(暂无匿称)

    文章不错,值得拜读

    0

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    2015-09-27 yese
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  5. [GetPortalCommentsPageByObjectIdResponse(id=127154, encodeId=046b12e1545b, content=文章不错,值得拜读, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Sep 15 07:37:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1850562, encodeId=5430185056284, content=<a href='/topic/show?id=46c682469e4' target=_blank style='color:#2F92EE;'>#肾功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82469, encryptionId=46c682469e4, topicName=肾功能)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28d456, createdName=yese, createdTime=Sun Sep 27 00:43:00 CST 2015, time=2015-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992800, encodeId=12d619928007f, content=<a href='/topic/show?id=02c6e999902' target=_blank style='color:#2F92EE;'>#羟乙基淀粉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79999, encryptionId=02c6e999902, topicName=羟乙基淀粉)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/JicbM9ddhTaNkKdhKQ8adCYWzVJQKZXsqSTg3ia12tmdibiaoTZTEjBqfVvmfODz1KpD73pKy4h1W0fAXj62kxGbQA/132, createdBy=d2132500095, createdName=ms5768352621950538, createdTime=Mon Oct 19 17:43:00 CST 2015, time=2015-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050489, encodeId=05142050489b1, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Apr 14 22:43:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59972, encodeId=d290599e2a9, content=这篇文章有一定深度, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 17:19:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59973, encodeId=e62b599e3e0, content=是一篇不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 17:19:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47974, encodeId=f2314e97475, content=值得看,好好收藏,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=169, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 14:06:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=43519, encodeId=ad9a435199b, content=甘露醇没干扰吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82b21632075, createdName=anesthesiaH, createdTime=Sat Nov 21 16:32:00 CST 2015, time=2015-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40732, encodeId=a0f540e3283, content=牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b531630898, createdName=pine007, createdTime=Sat Oct 24 21:34:00 CST 2015, time=2015-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1364054, encodeId=466c1364054a4, content=<a href='/topic/show?id=7c5615628ad' target=_blank style='color:#2F92EE;'>#ROS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15628, encryptionId=7c5615628ad, topicName=ROS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=acc3210, createdName=lsndxfj, createdTime=Tue Sep 01 10:43:00 CST 2015, time=2015-09-01, status=1, ipAttribution=)]
    2016-01-26 doctording1

    这篇文章有一定深度

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=127154, encodeId=046b12e1545b, content=文章不错,值得拜读, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Sep 15 07:37:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1850562, encodeId=5430185056284, content=<a href='/topic/show?id=46c682469e4' target=_blank style='color:#2F92EE;'>#肾功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82469, encryptionId=46c682469e4, topicName=肾功能)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28d456, createdName=yese, createdTime=Sun Sep 27 00:43:00 CST 2015, time=2015-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992800, encodeId=12d619928007f, content=<a href='/topic/show?id=02c6e999902' target=_blank style='color:#2F92EE;'>#羟乙基淀粉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79999, encryptionId=02c6e999902, topicName=羟乙基淀粉)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/JicbM9ddhTaNkKdhKQ8adCYWzVJQKZXsqSTg3ia12tmdibiaoTZTEjBqfVvmfODz1KpD73pKy4h1W0fAXj62kxGbQA/132, createdBy=d2132500095, createdName=ms5768352621950538, createdTime=Mon Oct 19 17:43:00 CST 2015, time=2015-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050489, encodeId=05142050489b1, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Apr 14 22:43:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59972, encodeId=d290599e2a9, content=这篇文章有一定深度, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 17:19:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59973, encodeId=e62b599e3e0, content=是一篇不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 17:19:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47974, encodeId=f2314e97475, content=值得看,好好收藏,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=169, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 14:06:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=43519, encodeId=ad9a435199b, content=甘露醇没干扰吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82b21632075, createdName=anesthesiaH, createdTime=Sat Nov 21 16:32:00 CST 2015, time=2015-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40732, encodeId=a0f540e3283, content=牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b531630898, createdName=pine007, createdTime=Sat Oct 24 21:34:00 CST 2015, time=2015-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1364054, encodeId=466c1364054a4, content=<a href='/topic/show?id=7c5615628ad' target=_blank style='color:#2F92EE;'>#ROS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15628, encryptionId=7c5615628ad, topicName=ROS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=acc3210, createdName=lsndxfj, createdTime=Tue Sep 01 10:43:00 CST 2015, time=2015-09-01, status=1, ipAttribution=)]
    2016-01-26 doctording1

    是一篇不错的文章

    0

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    2015-12-26 hixiaoluo

    值得看,好好收藏,谢谢分享

    0

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    2015-11-21 anesthesiaH

    甘露醇没干扰吗?

    0

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    2015-10-24 pine007

    0

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    2015-09-01 lsndxfj

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背景:羟乙基淀粉(HES)130/0.42在ICU中广泛用于体液复苏,但是它对于严重脓毒症患者的安全性和有效性还未得到确认。方法:在这个多中心,平行组对照,单盲的临床试验中,我们将ICU中因为严重脓毒症要进行体液复苏的病人随机分配至(HES)130/0.42治疗组和醋酸林格氏液(每天每千克体重33ml)治疗组,主要观测指标是随机治疗90天后死亡人数和出现晚期肾衰的人数。结果:804位随机分配治疗方

NEJM:注射抗休克药HES或具死亡风险

       正有越来越多的证据显示,世界各国重症监护病房(ICU)中最常使用的一种干预措施恐怕弊大于利。10月17日发布的一项临床试验数据显示,与那些仅使用生理盐水的病人相比,注射一种抗休克药——羟乙基淀粉(HES)——的患者更有可能需要肾透析或肾移植。并且HES患者更有可能在90天内死亡,尽管这种差异在统计学上并没有太大意义。   据美国《科学》杂志报道,作为

FDA:羟乙基淀粉溶液禁用于危重疾病治疗

  近日,美国食品药品管理局(FDA)发布警告指出,羟乙基淀粉(HES)溶液不应再用于危重疾病成年患者的治疗,包括脓毒症患者和重症监护病房(ICU) 入住患者。这是FDA在对有关HES溶液可能增加上述患者死亡和肾脏损害风险的数据进行分析后发出的警告。   FDA还建议,由于增加过多失血风险,应避免将HES作为血容量扩充剂用于心肺转流开放式心脏手术患者。   FDA分析了涉及数千例危重疾

BMC Anesthesiology:羟乙基淀粉不能改善术后患者恶心症状

国际麻醉指南建议静脉补液可以改善患者术后恶心、呕吐的症状。但尚无统一的治疗方案,针对这一问题,来自爱尔兰都柏林Rotunda医院的Conan McCaul等人进行了一项前沿性研究,该研究对比分析了等体积胶体液(羟乙基淀粉 130/0.4)和晶体液(Hartmann氏溶液)对妇产科腹腔镜术后患者恶心、呕吐症状的改善。该研究结果发表在2012年7月31日的BMC麻醉学杂志上(BMC Anesthesi

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