羟乙基淀粉(HES)与其他液体疗法:对肾脏功能的影响。

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抱怨TC,露丝,飞镖AB

羟乙基淀粉(HES)与其他液体疗法:对肾脏功能的影响。

科克伦数据库系统启2013年7月23日;(7):CD007594。cd007594.pub3 doi: 10.1002/14651858.。

PubMed ID

23881659 (在PubMed

]

文摘

背景:羟乙基淀粉(HES)是合成胶体常用的液体复苏取代血管内卷,但他们越来越与负面影响肾脏功能。这是一个更新的科克伦回顾在2010年首次出版。目的:研究他对肾功能的影响相对于其他液体复苏治疗在不同的患者群体。搜索方法:我们搜查了Cochrane肾组织的专业注册,科克伦中央登记的对照试验(中央,在Cochrane图书馆)、MEDLINE、EMBASE, MetaRegister和引用文章的列表。最近搜索完成11月19日,2012年。选择标准:随机对照试验(相关的)和quasi-RCTs相比,他是另一种液体治疗有效的预防或治疗血管内体积损耗。主要结果肾脏替代治疗(RRT),将土体肾功能衰竭和急性肾损伤(AKI)作为标准定义的步枪。数据收集和分析:筛选、选择、数据提取和质量评估每个检索文章是由两位作者使用标准化的形式。所有结果进行分析使用相对危险度(RR)和95%置信区间(95% CI)。作者联系当公布的数据是不完整的。 Preplanned sensitivity and subgroup analyses were performed after data were analysed with a random-effects model. MAIN RESULTS: This review included 42 studies (11,399 patients) including 19 studies from the original review (2010), as well as 23 new studies. Fifteen studies were excluded from the original review (nine retracted from publication due to concerns about integrity of data and six lacking individual patient creatinine data for the calculation of RIFLE criteria). Overall, there was a significant increase in the need for RRT in the HES treated individuals compared to individuals treated with other fluid therapies (RR 1.31, 95% CI 1.16 to 1.49; 19 studies, 9857 patients) and the number with author-defined kidney failure (RR 1.59, 95% CI 1.26 to 2.00; 15 studies, 1361 patients). The RR of AKI based on RIFLE-F (failure) criteria also showed an increased risk of AKI in individuals treated with HES products (RR 1.14, 95% CI 1.01 to 1.30; 15 studies, 8402 participants). The risk of meeting urine output and creatinine based RIFLE-R (risk) criteria for AKI was in contrast in favour of HES therapies (RR 0.95, 95% CI 0.91 to 0.99; 20 studies, 8769 patients). However, when RIFLE-R urine output based outcomes were excluded as per study protocol, the direction of AKI risk again favoured the other fluid type, with a non-significant RR of AKI in HES treated patients (RR 1.05, 95% CI 0.97 to 1.14; 8445 patients). A more robust effect was seen for the RIFLE-I (injury) outcome, with a RR of AKI of 1.22 (95% CI 1.08 to 1.37; 8338 patients). No differences between subgroups for the RRT and RIFLE-F based outcomes were seen between sepsis versus non-sepsis patients, high molecular weight (MW) and degree of substitution (DS) versus low MW and DS (>/= 200 kDa and > 0.4 DS versus 130 kDa and 0.4 DS) HES solutions, or high versus low dose treatments (i.e. >/= 2 L versus < 2 L). There were differences identified between sepsis versus non-sepsis subgroups for the RIFLE-R and RIFLE-I based outcomes only, which may reflect the differing renal response to fluid resuscitation in pre-renal versus sepsis-associated AKI. Overall, methodological quality of the studies was good. AUTHORS' CONCLUSIONS: The current evidence suggests that all HES products increase the risk in AKI and RRT in all patient populations and a safe volume of any HES solution has yet to be determined. In most clinical situations it is likely that these risks outweigh any benefits, and alternate volume replacement therapies should be used in place of HES products.

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