Title: Sugar isn't always so sweet
题目：糖并不总是那样甜的（羟乙基淀粉液的作用）
Author 作者: Haney Mallemat

A study by Perner, et al recently published in NEJM observed that using hydroxyethyl starch (HES) as a resuscitation fluid increased mortality and renal replacement therapy at 90 days as compared to lactated acetate.
Perner等最近在新英格兰医学杂志（NEJM）上发表了一篇有关羟乙基淀粉液（HES）在液体复苏中的应用，发现与乳酸乙酯液相比，HES增加了90天內的死亡率和肾脏替换治疗。
 
Another recent trial, called the “Crystalloid versus Hydroxyethyl Starch Trial” (CHEST) was a prospective randomized control trial from Australia comparing the use of 6% HES and 0.9% sodium chloride as a resuscitation fluid in the critically ill. 
另外一个最近称为‘晶体和羟乙基淀粉液试验（CHEST）’来自澳大利亚的前瞻性随机对照临床试验，对6％HES与0.9％氯化钠在危重病人进行液体复苏中的应用进行了比较。
 
With 7,000 patients enrolled (3,500 in each group), the CHEST trial is the largest single-trial of HES to date; the primary outcome was 90-day mortality and secondary outcomes were acute kidney injury (AKI) and renal-replacement therapy
这个CHEST研究包括了7,000个病人（每组有3,500人），是目前有关HES临床应用的最大的项目。最主要的预后标准是90天死亡率，另外一个标准是急性肾损伤和肾替代治疗。

The study concluded that there were no significant risks in morality or renal failure between groups, but significantly more patients in the HES group required renal replacement therapy.
此研究显示在死亡率和肾衰竭方面没有差别，但在HES组需肾替代治疗的病人有明显增加。
 
Bottom line: There is still no convincing data that patients receiving HES as part of their resuscitation have better outcomes compared to crystalloid (normal saline or lactated ringers) and there is increased harm with their use. Furthermore, the increased cost of HES does not appear to justify their routine use.
要点：还没有有利数据支持在液体复苏时使用HES有比晶体液（生理盐水或乳酸林格液）更好的预后效果。另外，HES的昂贵价格也限制了它在临床上的常规应用。

References 参考文献

Perner A., et al. Hydroxyethyl Starch 130/0.4 versus Ringer's Acetate in Severe Sepsis. NEJM. 2012 Jun 27.
 
MyBurgh, J. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. N Engl J Med. 2012 Oct 17.