对于新型快速降解羟乙基淀粉的当前认识

羟乙基淀粉（HES）是一种广泛用于纠正围手术期低血容量的血浆代替品。HES制剂依据浓度、摩尔取代级（MS）、平均分子量（Mw）、C2／C6取代比、溶剂以及来源的不同而命名。HES潜在的副作用包括：过敏反应、止血功能的改变导致出血增加、肾功能异常、蓄积作用和瘙痒。鉴于HES的潜在副作用，不同HES制剂间的区分极其重要，且HES制剂的特性不尽相同。第1代HES制剂表现为高Mw（〉450kD）、高MS（〉0．7），在止血作用、器官功能以及蓄积作用方面存在较多不良反应。本综述着重于研究具有更低Mw（130kD）及MS（〈0．5）、更快降解能力的新型（第3代）HES制剂是否更安全、副作用更少。数项研究证实了该HES制剂在凝血功能、肾功能、瘙痒以及蓄积作用等方面的安全性。新型HES制剂溶于血浆相容平衡溶液，仅含有生理量的钠离子以及氯离子，因此适用于低血容量的纠正。

Hydroxyethyl starch （HES） is a widely used plasma substitute for correcting perioperative hypovolemia. HES preparations are defined by concentration, molar substitution （MS）, mean molecular weight （Mw）, the C2/C6 ratio of substitution, the solvent, and the origin. The possible unwanted side effects of HES are anaphylactic reactions, alterations of hemostasis resulting in increased bleeding, kidney dysfunction, accumulation, and pruritus. In view of the potential side effects, it is crucial to distinguish among the different HES preparations; all HES preparations are not the same. The first generation of HES preparation showing a high Mw （ 〉450 kD） and a high MS （〉0.7） was associated with negative effects with regard to coagulation, organ function, and accumulation. This review is focused on whether modern （third generation）, more rapidly degradable HES preparations with a lower Mw （ 130 kD） and a lower MS （〈0.5） are safer and have fewer side effects. Several studies demonstrated that such modern HES preparations appear to be safe with regard to hemostasis, kidney function, itching, and accumulation. Modern HES preparations are dissolved in balanced, plasma-adapted solutions that no longer contain unphysiological amounts of sodium and chloride and are thus suitable for correcting hypovolemia.