容量復蘇中明膠安全性的薈萃分析ppt課件

1、容量復蘇中明膠安全性的薈萃分析容量復蘇中明膠安全性的薈萃分析2019年年1月月23日日ContentsContentsIntroductionMethodsResultsConclusionIntroductionIntroductionn動物膠原的降解產物n平均分子量為60-80 kDa n因凝點高于室溫n所以這種明膠未應用于臨床n1915年，對明膠進行首次驗證nHogan J. JAMA 1915;64:721-726n但這種明膠難以滅菌n凝點高于室溫n由于分子量大于100,000道爾頓，因此粘稠度大n5%明膠溶液nJacobson S and Smyth C. Arch Int Med

2、1944;74:254-247n通過水解作用保持其流動性n二戰(zhàn)期間應用于50例患者n成功復蘇IntroductionIntroductionGenerally, gelatin solutions are considered to have no dosage-related side effects, specifically not impairing surgical hemostasis 7, 8 , and being less harmful to the kidneys than other non-protein colloids 9, 10.IntroductionIntr

3、oductionPerel et al. 13 compared gelatin to crystalloid fluids in 506 critically ill adult patientsBunn et al. 15 compared gelatin with albumin or PPF in 636 patients thought to need volume replacement.IntroductionIntroductionNo review found a significant effect on mortality. However, effects on ren

4、al function or blood product use were not systematically explored.MethodsMethodsEligibility criteriaInclusion criteria(1) prospective, randomizedcontrolled trials(2) hospital or pre-hospital setting(3)patients with acute hypovolemia with need for fluidresuscitation(4) study fluid was administered fo

5、r resus-citation(5) at least one intervention group receivedgelatin solution(6) at least one intervention groupreceived another resuscitation fluidMethodsMethodsExclusion criteria (1) only volunteers or blood donors were recruited(2) administration of fluid was solely for the purpose of volume prelo

6、ading before anesthesia including volume loading for neural block , acute normovolemic or hypervolemic hemodilution without subsequent intra- or postoperative use(3)retracted studies 16(4) unsuitable control fluids, i.e., other synthetic colloids (as those may have similar risk profile)(5) study res

7、ults published in a language other than English, German, French, or Italian.MethodsMethodsSearch strategyOvid Medline(1948May 2019)EMBASE (1947May 2019)Cochrane Central Register of Controlled Trials (CEN-TRAL) (through May 2019)MethodsMethodsData analysisSPSS 17.0random-effects model (Rev Man 5.1, C

8、ochrane Collaboration)ResultsResultsResultsResultsResultsResultsResultsResultsResultsResultsResultsResultsResultsResultsResultsResultsDiscussionDiscussionsynthetic colloidsImprecise resultLittle research Critically ill patientsConclusionConclusionGelatins were introduced into clinical practice before legislation in the after math of the thalidomide tragedy made clinical proof of safety mandatory 6. Despite over 60 years of clinical experience with its use, the safety of gelatin in all settings in which it is used cannot be reliably assessed and confirmed. We suggest the need to investigate a