Critical Care（2015.3）：小儿心内直视手术中可安全使用6%HES 130/0.4

南粤麻医

来自比利时的研究，纳入1495名患儿，小儿心内直视手术中使用6%HES 130/0.4（万汶）用于容量替代治疗，与白蛋白相比具有同样的安全效果，术后肾功能衰竭、并发症与死亡率均无显著差异，而液体入量、输注红细胞及FFP量、输血患儿数均低于白蛋白组。

[size=13.600000381469727px][size=13.600000381469727px]ResearchEfficacy and safety of 6% hydroxyethyl starches 130/0.4 (Voluven®) for perioperative volume replacement in children undergoing cardiac surgery: a propensity-matched analysis[size=13.600000381469727px]

[size=1em]Philippe Van der Linden[size=11.199999809265137px]1*, Melanie Dumoulin[size=11.199999809265137px]1, Celine Van Lerberghe[size=11.199999809265137px]1, Cristel Sanchez Torres[size=11.199999809265137px]1,Ariane Willems[size=11.199999809265137px]2 and David Faraoni[size=11.199999809265137px]3

[size=13.600000381469727px][size=13.600000381469727px][size=13.600000381469727px]

• [size=1em]*Corresponding author:         Philippe Van der Linden [size=13.600000381469727px][email protected]
  
  

[size=1em][size=13.600000381469727px]Author Affiliations

[size=13.600000381469727px]

[size=1em]For all author emails, please [size=13.600000381469727px]log on.

[size=13.600000381469727px]

[size=1em]Critical Care 2015, 19:87  doi:10.1186/s13054-015-0830-z

Published: 17 March 2015

Abstract (provisional)

[size=13.600000381469727px]Introduction Six percent hydroxyethyl starch (HES) 130/0.4 is considered as an alternative to human albumin (HA) and crystalloids for volume replacement in children undergoing cardiac surgery. In this large propensity-matched analysis, we aimed to assess efficacy and safety of replacing HA with HES for intra-operative volume therapy in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods We retrospectively reviewed our database including children who underwent cardiac surgery between January 2002 and December 2010. Four percent HA was used until 2005, and replaced by HES thereafter. Demographic, intra- and postoperative blood loss and blood components transfusion were recorded, together with the incidence of postoperative complications, and mortality. We used a propensity-matched analysis, using 13 possible confounding factors, to compare children that received intraoperatively either HES or HA. Primary objectives included the effects of both fluids on intra-operative fluid balance (difference between fluids IN and fluids OUT: efficacy), and blood loss and exposure to allogeneic blood products (safety). Secondary safety outcomes were mortality, and the incidence of postoperative renal dysfunction. Results From 1832 children reviewed, 1495 were included in the analysis. Intraoperative use of HES was associated with a less positive fluid balance. Perioperative blood loss, volume of red blood cells and fresh frozen plasma administered, and number of children transfused were also significantly lower in the HES group. No difference was observed regarding the incidence postoperative renal failure requiring renal replacement therapy, morbidity and mortality. Conclusions These results confirmed that the use of HES for volume replacement in children during cardiac surgery with CPB is as safe as human albumin. In addition, its use might be associated with less fluid accumulation. Further large studies are needed to assess if the reduction in fluid accumulation could have a significant impact on postoperative morbidity and mortality.

http://ccforum.com/content/19/1/87/abstract

附件为全文