某院羟乙基淀粉临床应用合理性分析

Rationality Analysis of Hydroxyethyl Starch Clinical Application in A Hospital

目的:为临床合理应用羟乙基淀粉(HES)及防范相关不良反应发生提供参考。方法:回顾性分析某院2014年7月住院患者使用HES的情况,考察其用法用量、适应证等情况及用药前后肾功能、凝血功能等监测指标变化,并评价其使用合理性。结果:该院所用HES为HES 200/0.5氯化钠注射液,为第二代HES。347例患者中,295例在用药前监测了肾功能指标,结果正常,21例在用药后监测了肾功能指标,结果正常;同时,326例在用药前后监测了凝血功能指标,结果均正常。该院HES未用于有严重脓毒症、肾功能不全及有凝血功能障碍的患者。结论:使用HES存在肾损害和引起凝血功能障碍的风险,故用药前后应密切监测相关指标,防范不良反应的发生;并且在其临床应用中需严格掌握适应证、用法用量和注意事项。另外,建议改用安全性较高的第三代HES替换第二代HES。

OBJECTIVE： To provide reference for the clinical rational application and preventing the adverse reactions of hy- droxyethyl starch （HES）. METHODS： The HES application of inpatients in a hospital in Jul. 2014 were retrospectively analyzed, the usage and dosage, indications, and the changes of renal fimctions and blood coagulation fimction before and after HES treat- ment were detected, and the application rationality was evaluated. RESULTS： The usage of HES in the hospital was hydroxyethyl starch 200/0.5 and Sodium chloride injection, which was the second generation of HES. In the 347 patients, 295 patients had moni- tored the renal functions before the HES treatment, the result was normal; and 21 patients had monitored the renal functions after HES treatment, the result was normal. Meanwhile, 326 patients had monitored the blood coagulation functions before and after HES treatment, the results were normal. HES was not used for the patient of severe sepsis, renal dysfunctions and coagulopathy in this hospital. CONCLUSIONS：The application of lIES can induce renal damage and coagulation disorder, so relevant indicators should be closely monitored before and after treatment to prevent the incidence of adverse reactions; further more, clinicians should strictly handle indications, usage and dosage and precautions during the clinical application; in addition, it is suggested to replace the second generation of HES by the third generation, which is more safer.