对比平衡盐溶液和6%羟乙基淀粉在腹部大外科目标导向治疗中的应用：一项系统综述和荟萃分析

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-04-19 DOI:10.1016/j.amjsurg.2025.116355

Rui Lu , Srisuluk Kacha , Natsuda Phothikun , Atirut Supphapipat , Kaweesak Chittawatanarat

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引用次数: 0

摘要

目标导向液体疗法（GDFT）可改善各种手术的术后效果，但平衡盐溶液（BSS）和羟乙基淀粉（HES）之间的最佳液体选择仍存在争议。这项荟萃分析比较了在择期大腹部手术中使用 BSS 和 6% HES 进行 GDFT 的术后效果。通过全面的数据库搜索，发现了 2000 年至 2024 年间发表的 8 项 RCT（1739 名患者）。在总体术后并发症方面未发现明显差异[RR 1.04 (95 % CI 0.90-1.20); p = 0.59]，包括肾脏、心血管、呼吸系统并发症或死亡率。然而，BSS 所需的术中液体量明显更高[SMD 0.61 (95 % CI 0.42-0.80); p <0.001]，并导致更大的术后液体平衡[SMD 0.39 (95 % CI 0.20-0.59); p <0.001]。不应常规使用 6% HES。使用 BSS 的 GDFT 能以较低的成本实现相同的效果，且无出血风险。

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Comparative balanced salt solution and 6 % hydroxyethyl starch in goal-directed therapy for major abdominal surgery: A systematic review and meta-analysis

Goal-directed fluid therapy (GDFT) improves postoperative outcomes in various surgeries, but the optimal fluid choice between balanced salt solutions (BSS) and hydroxyethyl starch (HES) remains debated. This meta-analysis compared postoperative outcomes of GDFT using BSS versus 6 % HES in elective major abdominal surgery. Comprehensive database searches identified eight RCTs (1739 patients) published between 2000 and 2024. No significant differences were found in overall postoperative complications [RR 1.04 (95 % CI 0.90–1.20); p = 0.59], including renal, cardiovascular, respiratory complications, or mortality. However, BSS required significantly higher intraoperative fluid volumes [SMD 0.61 (95 % CI 0.42–0.80); p < 0.001] and led to greater postoperative fluid balance [SMD 0.39 (95 % CI 0.20–0.59); p < 0.001]. 6 % HES should not be used routinely. GDFT using BSS achieves the same outcomes at a lower cost and without the risk of bleeding.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.