Anesthesiology：羟乙基淀粉用于非心脏手术患者产生剂量依赖性的肾脏毒性

南粤麻医

该研究发现，羟乙基淀粉用于非心脏手术患者产生剂量依赖性的肾脏毒性。有趣的是，即便如此，其对住院风险及90d死亡率并无影响。

Anesthesiology. 2014 Oct;121(4):730-9. doi: 10.1097/ALN.0000000000000375.

Effect of hydroxyethyl starch on postoperative kidney function in patients having noncardiac surgery.

Kashy BK1, Podolyak A, Makarova N, Dalton JE, Sessler DI, Kurz A.

Author information

Abstract

BACKGROUND:

Whether intraoperative use of hydroxyethyl starch impairs kidney function remains unknown. The authors thus tested the primary hypothesis that Hextend promotes renal injury in surgical patients. Secondarily, the authors evaluated the dose-outcome relationship, in-hospital and 90-day mortality, and whether the relationship between colloid use and acute kidney injury (AKI) depends on baseline risk for AKI.

METHODS:

The authors evaluated the data of 44,176 adults without preexisting kidney failure who had inpatient noncardiac surgery from 2005 to 2012. Patients given a combination of colloid and crystalloid were propensity matched on morphometric, and baseline characteristics to patients given only crystalloid. The primary analysis was a proportional odds logistic regression with AKI as an ordinal outcome based on the Acute Kidney Injury Network classification.

RESULTS:

The authors matched 14,680 patients receiving colloids with 14,680 patients receiving noncolloids for a total of 29,360 patients. After controlling for potential confounding variables, the odds of developing a more serious level of AKI with Hextend was 21% (6 to 38%) greater than with crystalloid only (P = 0.001). AKI risk increased as a function of colloid volume (P < 0.001). In contrast, the relationship between colloid use and AKI did not differ on baseline AKI risk (P = 0.84). There was no association between colloid use and risk of in-hospital (P = 0.81) or 90-day (P = 0.02) mortality.

CONCLUSION:

Dose-dependent renal toxicity associated with Hextend in patients having noncardiac surgery is consistent with randomized trials in critical care patients.

PMID: 25054470

http://www.ncbi.nlm.nih.gov/pubmed/?term=25054470

鸿运当头888

这就是说可以用，意义在哪里