课件：围手术期的基本药物治疗.ppt

N Engl J Med.?2012 Jul 12;367(2):124-34. Epub 2012 Jun 27. Hydroxyethyl starch 130/0.42 versus Ringers acetate in severe sepsis. Perner A,?Haase N,?Guttormsen AB,?Tenhunen J,?Klemenzson G,??neman A,?Madsen KR,?M?ller MH,?Elkj?r JM,?Poulsen LM,?Bendtsen A,?Winding R,?Steensen M,?Berezowicz P,?S?e-Jensen P,?Bestle M,?Strand K,?Wiis J,?White JO,?Thornberg KJ,?Quist L,?Nielsen J,?Andersen LH,?Holst LB,?Thormar K,?Kj?ldgaard AL,Fabritius ML,?Mondrup F,?Pott FC,?M?ller TP,?Winkel P,?Wetterslev J;?6S Trial Group;?Scandinavian Critical Care Trials Group. Collaborators (122) Source Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. anders.perner@rh.regionh.dk Erratum in N Engl J Med. 2012 Aug?2;367(5):481. Abstract BACKGROUND: Hydroxyethyl starch (HES) [corrected] is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis. METHODS: In this multicenter, parallel-group, blinded trial, we randomly assigned patients with severe sepsis to fluid resuscitation in the ICU with either 6% HES 130/0.42 (Tetraspan) or Ringers acetate at a dose of up to 33 ml per kilogram of ideal body weight per day. The primary outcome measure was either death or end-stage kidney failure (dependence on dialysis) at 90 days after randomization. RESULTS: Of the 804 patients who underwent randomization, 798 were included in the modified intention-to-treat population. The two intervention groups had similar baseline characteristics. At 90 days after randomization, 201 of 398 patients (51%) assigned to HES 130/0.42 had died, as compared with 172 of 400 patients (43%) assigned to Ringers acetate (relative risk, 1.17; 95% confidence interval [CI], 1.01 to 1.36; P=0.03); 1 patient in each group had end-stage kidney failure. In the 90-day period, 87 patients (22%) assigned to HES 130/0.42 were treated with renal-replacement therapy versus 65 patients (16%) assigned to