The risk of infusing gelatin? Die-hard misconceptions and forgotten (or ignored) truths.
The risk of infusing gelatin? Die-hard misconceptions and forgotten (or ignored) truths.
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输注明胶有风险吗？
作者：
A. Pisano;G. Landoni;R. Bellomo
液体治疗被认为是围手术期和重症监护医学的基石。然而，不同国家使用的液体类型差异很大。合成胶体可能会对凝血产生负面影响，并具有潜在的肾毒性。“现代”羟乙基淀粉（HES）被广泛使用，直到最近，欧洲药品管理局在2013年限制了其与危重患者死亡率和肾脏替代治疗风险的相关性。由于传统上认为合成胶体作为体积扩张剂比晶体更有效（尽管其功效可能被大大高估），因此担心实际上被剥夺了羟乙基淀粉的医生可能会再次依赖“旧”明胶。本文旨在警告临床医生，明胶具有其他合成胶体的所有潜在不良反应，甚至可能比羟乙基淀粉更具肾毒性。此外，与晶体相比，明胶对结果没有有益的影响（相反，它们甚至可能增加死亡率），并且也更昂贵。因此，应强烈劝阻“回归”明胶。
Fluid therapy is considered a cornerstone of perioperative and critical care medicine. However, the type of fluids used varies widely among different countries. Synthetic colloids may negatively affect coagulation and are potentially nephrotoxic. "Modern" hydroxyethyl starches (HES) were widely used until recently when their association to mortality and renal replacement therapy risk among critically ill patients brought to restriction by the European Medicines Agency in 2013. Since synthetic colloids are traditionally thought to be much more effective as volume expanders than crystalloids (although their efficacy is probably largely overrated), there is concern that physicians, practically deprived of HES, could be tempted to rely again on "old" gelatins. The aim of this contribution is to warn clinicians that gelatins share all potential adverse effects of other synthetic colloids, and are possibly even more nephrotoxic than HES. Moreover, gelatins have no beneficial effects on outcomes as compared with crystalloids (on the contrary, they might even increase mortality), and are also more expensive. Accordingly, a "return" to gelatins should be strongly discouraged.