羟乙基淀粉在脓毒症液体复苏中应用与争论

Debate on use of hydroxyethyl starch for fluid resuscitation in septic patients

液体复苏是脓毒症治疗十分重要的基础环节,而液体种类的选择是此领域近年来的热门议题之一。最新几项多中心、随机对照研究(RCT)报道,脓毒症病人液体复苏治疗时使用羟乙基淀粉130/0.4或0.42(HES 130/0.4或0.42)可导致肾脏替代治疗(RRT)的需求及90 d死亡风险显著增加。系统、深入地分析现有研究报告资料发现,HES 130/0.4或0.42引起急性肾损伤(AKI)的临床证据欠充分;与晶体液比较,HES 130/0.4或0.42引起脓毒症病人90 d病死率升高的结论在不同RCT研究中存在高异质性,且此结论可能受混杂因素的影响。因此,对HES 130/0.4或0.42在脓毒症病人中应用安全性的客观评价仍有赖于进一步获得更多可靠的临床数据。

Fluid resuscitation is the most importantelementary care in the management of sepsis. In recent years,choice of fluid types has become one of the hot debate topicsin the field. Based on recent RCTs, use of hydroxyethyl starch130/0.4 or 0.42（HES 130/0.4 or 0.42） for volume therapy hasbeen associated with an increased need of renal replacementtherapy （RRT） notably and high risk of 90-day mortality inseptic patients significantly. According to a systematical andintensive analysis on the available published data, evidencewas insufficient for identifying HES 130/0.4 or 0.42-inducedacute kidney injury （AKI） in patients with sepsis. Furthermore,a high heterogeneity on HES 130/0.4 or 0.42 associatedmortality was found among RCTs in comparison withcrystalloids in septic patients. And the results of HES 130/0.4 or 0.42 associated increase of mortality were likelyconfounded in the original trials. Therefore, further valid datais needed for objectively evaluating the safety of HES 130/0.4or 0.42 administration for volume therapy in patients withsepsis.