羟乙基淀粉 vs 晶体液治疗脓毒血症和感染性休克患者德国 SepNet VISEP 试验结果（英文）课件.ppt

3,170 ml HES;Hemodynamic effects;;;;;Effects on renal function;75.00;;;Mean SOFA Score;0.001;;;;VISEP Trial (HES vs. Ringers′ Lactate)  - HES 22 ml/kg/BW -;;Progression of mortality from 28 days to 90 days;100;0.003;;0.615;;0.142;Volume resuscitation with HES 10% (200/0.5) results in faster hemodynamic stabilisation. Acute renal failure and need for renal replacement therapy occurred more often in the HES group 28-day mortality is not significantly different between study groups 90-day mortality tends to be higher (33.9% vs 41.0% (p=0.11) in the HES group ;Increasing cumulative dosages of HES are associated with an increase in 90-day mortality. (p=0.0015). Increasing cumulative dosages of HES, but not Ringers′lactate are associated with renal failure and renal replacement therapy; independently from baseline creatinine clearance. ;Increasing cumulative dosages of Ringers′ lactate and HES are associated with an increase in 90-day mortality. This effect is more marked in patients receiving HES (p=0.0015). Increasing cumulative dosages of HES, but not Ringers′lactate are associated with renal failure and renal replacement therapy; independently from baseline creatinine clearance. ;HES 10% (200/0.5) can not be recommended for patients with severe sepsis and other patients at risk for the development of acute renal failure. The safety margin for HES is narrow. Exceeding the recommended upper dose limit (20 ml/kg BW / day) should be avoided. Whether newer HES preparations can be safely used in patients at risk for the development of acute renal failure remains to be elucidated. ;After the results of the VISEP trial were available i.e. Feb.1st 2006 we stopped the use of HES 130/0.4 (Voluven) and replaced it by succinylated gelatin 4%;Impact of change in type of colloid – HES 6 %, 130/04 vs. succinylated Gelatin 4% on resource use costs;Association between change in type of colloid patient morbidity/mortality - HES 6% 130/0.4 vs. Gelatin 4%;Allergic reactions attr