Title: More Bad News for HES
题目： 更多的有关HES的坏消息
Author 作者: Haney Mallemat

Hydroxyethyl starch (HES) is a colloid used for volume resuscitation in critically-ill patients.
羟乙基淀粉（HES）是用于病危患者容量复苏一种胶体 。
Previous studies have compared crystalloids to HES during fluid resuscitation and have demonstrated that HES has an increased cost with more adverse effects. Adverse effects may include:
以往的研究对晶体液和HES在液体复苏中进行比较，发现HES不但成本高而且副作用多。其副作用包括：
Coagulopathy 凝血功能障碍
Acute kidney injury 急性肾损伤
Increased mortality 死亡率增加

In the United States, the Federal Drug Administration published a warning on June 24th 2013 with respect to the use of HES in critically ill adult patients. Specifically, it warned about the use of HES in patients,
在美国，联邦药物管理局在2013年6月24日发表了一份有关危重成人患者使用HES。这个警告明确警示HES在下列病人中的应用;
with sepsis 败血症
with pre-existing kidney injury 已有肾损伤
admitted to the ICU 住进加护病房
undergoing heart surgery with cardiopulmonary bypass 体外循环心脏手术

If a decision to use HES is made, the FDA warning advises to:
如果决定使用HES，FDA的警告建议：

discontinue use of HES at the first sign of renal injury or coagulopathy
停止使用HES如果出现肾损伤或凝血功能障碍的迹象
continue to monitor renal function for at least 90 days (all patients)
至少要继续监测肾功能 90天（所有患者）

Bottom line: With an increased cost and evidence of harm compared to crystalloids, it appears the indications for use of HES are rapidly declining.
要点：与晶体液相比，HES成本高和有更多的有害证据，它的使用适应症乎正在迅速下降。

References 参考文献：
http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ucm358271.htm
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.
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