医药卫生羟乙基淀粉 s 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

Hemohes ? 10% Fa. B. Braun (HES 200 / 0.5) Hydroxyethyl starch mean molecular weight 200 000 Degree of substitution 0.45-0.55 C2/C6 ratio 6:1 Manufacturer’s recommended maximal daily dose ≤ 20 ml / kg BW per day ≈ 2.0 g / kg (≈ 1,500 ml per day for a 75 kg patient) Volume efficacy 130-150% Volume effect: medium (3-4 hours) Volume therapy  - HES Characteristics - Dieterich H-J.: J Trauma 2003 Reduction of capillary leakage and tissue edema Decreased tissue injury after ischemic reperfusion Preservation of gastric-mucosal blood flow and pHi Lower incidence of pulmonary edema Decreased endothelial activation and leucocyte endothelial cell interaction Improved microcirculatory flow and reduced leucocyte adhesion Potential Beneficial Effects of HES Schortgen F. et al. Lancet 2001;357:911-916 However: Renal failure and HES Population without renal failure Days N=64 N=65 P=0.018 Even if regulatory agencies and pharmaceutical companies do not seem to be interested in responding to this important question, international researchers should try to obtain such an answer. Indeed,new starches are or will be proposed in the future, and there is presently no proof that they are devoid of the same renal effects. Are we sure that these lesions do not frequently occur in patients with renal diseases, renal ischemia, and in critically ill patients? Riou B et al. Intensive Care Med (1999) 25: 1340 ? HES is HES ? Observation periods of HES studies w/o renal impairment 1 day London et al. (J Cardiothoracic Anesth 1989) 14 days Deman et al. (Nephrol Dial Transplant 1999) 6 hours Vogt et al. (Anesth Analg 1996) 5 days Boldt et al. (Intense Care Med 1998) 1 day Allison et al. (J Trauma 1999) 3 days Kumle et al. (Anesth Analg 1999) perioperative - 1 day Boldt et al (J Cardiothoracic Anesth 2000) perioperative Dehne et al. (J Clin Anesth 2001) 3 days (blood); 4 days (urine) Jungheinrich et al. (Anesth Analg 2002) 2 days Boldt et al. (Intens Care Med 2003) 8 days; FU 3 da