BJA：剖宫产患者术中使用HES优于乳酸林格氏液

南粤麻医

在危重病领域几乎一棍子将羟乙基淀粉拍死的情况下，HES在麻醉科及围术期的使用依然强劲，是麻醉科医生无知，还是外科医生无畏，可谓仁者见仁智者见智。但是，以数据说话，而不是见风就是雨，透过现象看本质，探索数据背后的故事，也许更值得专业人士思考。

最新BJA发表多中心、随机、对照、双盲研究，结果发现，剖宫产患者使用HES联合RL更具优势，较之单独使用RL更少发生低血压。

该文章的临床注册号为：NCT00694343

因为影响力较大杂志的几篇文章，羟乙基淀粉的使用备受质疑，甚至于成为众多商家的矛头指向。值得赞许的是，麻醉领域对这些文献的质疑从一开始久未停止，持续至今，同时也开展了一些相关的临床及基础研究。虽然结果报道不一，但求真务实的态度值得褒奖。

希望看到更多关于专业内容的专业争论，谢绝非专业性讨论。
附件为文章全文。

Br J Anaesth. 2014 Sep;113(3):459-67. doi: 10.1093/bja/aeu103. Epub 2014 Jun 26.

6% Hydroxyethyl starch (130/0.4) vs Ringer's lactate preloading before spinal anaesthesia for Caesarean delivery: the randomized, double-blind, multicentre CAESAR trial‡.

Mercier FJ1, Diemunsch P2, Ducloy-Bouthors AS3, Mignon A4, Fischler M5, Malinovsky JM6, Bolandard F7, Aya AG8, Raucoules-Aimé M9, Chassard D10, Keita H11, Rigouzzo A12, Le Gouez A13; CAESAR Working Group.

Author information

Abstract

BACKGROUND:

Vasopressor administration is recommended to prevent hypotension during spinal anaesthesia (SA) for elective Caesarean delivery. We aimed to test the superior efficacy and ensure safety of a hydroxyethyl starch (HES) vs a Ringer's lactate (RL) preloading, when combined with a phenylephrine-based prophylaxis.

METHODS:

A total of 167 healthy parturients undergoing elective Caesarean delivery under SA were included in this multicentre, randomized, double-blind study. Patients received 500 ml of 6% HES (130/0.4)+500 ml of RL (HES group) or 1000 ml of RL (RL group) i.v. before SA. After SA, i.v. phenylephrine boluses were titrated when systolic arterial pressure (SAP) was below 95% of baseline. The primary outcome was the incidence of maternal hypotension (SAP <80% of baseline).

RESULTS:

The incidence of both hypotension and symptomatic hypotension (i.e. with dizziness, nausea/vomiting, or both) was significantly lower in the HES group vs the RL group: 36.6% vs 55.3% (one-sided P=0.025) and 3.7% vs 14.1%. There was no significant difference in total phenylephrine requirements [median (range): 350 (50-1800) vs 350 (50-1250) μg]. The decrease in maternal haemoglobin value the day after surgery was similar in the two groups [1.2 (1.0) vs 1.0 (0.9) g dl(-1)]. There was no detectable placental transfer of HES in six umbilical cord blood samples analysed in the HES group. Neonatal outcomes were comparable between the groups.

CONCLUSIONS:

Compared with a pure RL preloading, a mixed HES-RL preloading significantly improved prevention of both hypotension and symptomatic hypotension based on early phenylephrine bolus administration and did not induce adverse effects.

CLINICAL TRIAL REGISTRATION: NCT00694343 (http://clinicaltrials.gov).

© The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected].

KEYWORDS: Caesarean section; anaesthesia, spinal; fluid therapy, hydroxyethyl starch; fluid therapy, preloading; hypotension

PMID: 24970272

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