羟乙基淀粉溶液的容量复苏：近期文献综述

Volume resuscitation with HES-solutions ： A review of the latest literature

对围术期或危重症病人实施个体化液体管理,需要谨慎权衡利弊,这是一项极具挑战性的日常临床工作.全世界近几十年来,羟乙基淀粉溶液一直用于围术期或危重症病人的容量复苏,然而2013年10月欧洲药品管理局提议,对于脓毒症、烧伤、肾功能不全及严重凝血功能障碍等危重症病人,一般情况下不宜使用羟乙基淀粉溶液.但这项提议基于的三个主要的随机对照试验,均因其设计方案和数据分析而倍受质疑.本文简要概述了羟乙基淀粉溶液的药代动力学和药效动力学;各代羟乙基淀粉溶液之间的不同点;围术期病人与危重症病人之间病理生理学的差异.此外,本文还对近来有关羟乙基淀粉溶液用于危重症病人和心脏手术围术期病人容量复苏的随机对照试验,进行了评论.

Fluid administration in perioperative and critically ill patients is an everyday challenge that requires careful consideration between risks and benefits for the individual patient.Hydroxyethylstarch （HES） preparations have been used for volume resuscitation in these patients for decades worldwide.In October 2013,however,the European Medicines Agency （EMA） recommended not to use HES solutions in patients with sepsis,burn injuries,renal impairment,severe coagulopathy as well as critically ill patients in general.This recommendation was based on the results of mainly three randomized,controlled trials; all of them being heavily criticized for the study protocol and data interpretation.This review provides a brief overview over the pharmacodynamics and pharmacokinetics of HES preparations,the differences between individual HES generations and the pathophysiology of critically ill and perioperative patients.Furthermore,recent randomized,controlled trials investigating volume resuscitation with HES in critical ill patients and in the perioperative setting with a special focus on cardiac surgery were critically discussed.