Critical Care（2015.3）：ICU非脓毒症患者使用6%HES并不增加死亡率

南粤麻医 · 发表于 2015-3-19 20:07:00

本帖最后由南粤麻医于 2015-3-19 21:29 编辑

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新华医院王英伟教授发表在Critical Care的最新Meta分析发现，与其他液体相比，ICU内非脓毒症患者使用6%羟乙基淀（HES）不增加死亡率、肾替代治疗、出血量及输血量等，不过文章也指出纳入的研究样本量较小、质量不高。该研究纳入22篇文献，6,064例患者。

Research6% Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit: a meta-analysis of randomized controlled trialsBin He1†, Bo Xu1†, Xiaoxing Xu2, Lixia Li3, Rongrong Ren1, Zhiyu Chen1, Jian Xiao4, Bin Xu5* and Yingwei Wang1*

*Corresponding authors: Bin Xu [email protected] - Yingwei Wang[email protected]
† Equal contributors

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Critical Care 2015, 19:92 doi:10.1186/s13054-015-0833-9

Bin He and Bo Xu contributed equally to this work.

Published: 19 March 2015

Abstract (provisional)

Introduction Use of hydroxyethyl starch (HES) in septic patients is reported to increase the mortality and incidence of renal replacement therapy (RRT). However, whether or not use of HES would induce the same result in non-septic patients in the intensive care unit (ICU) remains unclear. The objective of this meta-analysis was to evaluate 6% HES versus other fluids for non-septic ICU patients. Methods Randomized controlled trials (RCTs) were searched from Pubmed, OvidSP, Embase database and Cochrane Library, published before November, 2013. A meta-analysis was made on the effect of 6% HES versus other fluids for non-septic ICU patients, including mortality, RRT incidence, bleeding volume, red blood cell (RBC) transfusion and fluid application for non-septic patients in ICU. Results Twenty-two RCTs were included, involving 6,064 non-septic ICU patients. Compared with the other fluids, 6% HES was not associated with decreased overall mortality (RR = 1.03, 95%CI: 0.09 to 1.17; P = 0.67; I 2 = 0). There was no significant difference in RRT incidence, bleeding volume and red blood cell transfusion between 6% HES group and the other fluid groups. However, patients in HES group received less total intravenous fluids than those receiving crystalloids during the first day in ICU (SMD = −0.84; 95%CI: −1.39 to −0.30; P = 0.003, I 2 = 74 %). Conclusions This meta-analysis found no increased mortality, RRT incidence, bleeding volumes or RBC transfusion in non-septic ICU patients, but the sample sizes were small and the studies generally were of poor quality.

http://ccforum.com/content/19/1/92/abstract

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