Doctors debate safety of starch drips : Nature News & Comment
The humble drip is one of the most common tools in medicine, used to put a variety of fluids into patients to treat a host of medical conditions. But a paper 1 published in the New England Journal of Medicine (NEJM) last month has fuelled smouldering doubts about one such type of fluid — hydroxyethyl starch. Scientists are now preparing for a US Food and Drug Administration (FDA) meeting next week in Bethesda, Maryland, where they will try to agree on whether the use of starches should be discontinued.医学研究人员正在探讨医生常用于危重病人身上的某种液体的安全性问题，实际上很有可能弊大于利。静脉输液是医学上很常见的方法，将各种液体输入病人体内，用来治疗很多病症。但是，上个月发表于新英格兰医学杂志 （NEJM） 中的 一篇论文对其中一种常用的液体提出了质疑 — — 羟乙基淀粉。科学家们现在为美国食品和药物管理局 (FDA) 准备下周在马里兰州贝塞斯达的会议，讨论是否应停用或继续使用此淀粉。
The NEJM study looked at people in intensive-care units (ICUs) with severe sepsis — whole-body inflammation caused by an infection, which results in a drop in blood pressure that must be corrected using fluid injections to expand the volume of their blood. Starches have been used in the belief that they are less likely to leach out of the circulatory system than saline. But the researchers found that after 90 days, 201 patients of 398 given starch had died, compared with 172 of 400 given a fluid called Ringer's acetate.
NEJM的研究对重症监护室内重度败血症（由炎症引起的全身血液感染）病人的输液情况进行观察，病人血压低时需要通过输液来扩充血容量，与盐类相比，淀粉类液体不会逸到血管外而作为首选。但是，研究者发现，90天后，398例输注淀粉类液体的病人死亡了201例，输入林格液（含盐非淀粉类）的400例病人只有172例死亡。
Exactly how often starch is used in hospitals around the world is unclear, with practice varying widely between countries and even between doctors in the same hospitals. But it is “highly used”, says Anders Perner, an intensive-care doctor at Copenhagen University Hospital and lead author of the study.
全球范围内，究竟淀粉类液体在医院里常用到什么程度，很难说清楚。不同国家之间和甚至同一医院不同医生之间的做法都不一样。说安德斯朴尼说，它的确"很常用‘’，他是哥本哈根大学医院重症监护室的医生，也是该研究的第一作者。朴尼说，淀粉是医生工具箱中的标准选项 — — 但是这样是不对的。他说："我们得到结果当天就改变做法了。但是许多斯堪的纳维亚监护室医生还在这样做。"
There are a number of different types of hydroxyethyl starch on the market, and some doctors question how well studies based on one kind will apply to others. It is also unclear how findings concerning people with sepsis will affect the use of starch to treat other conditions, especially outside ICUs — in operating theatres, for example. But the NEJM paper does indicate that the problems may be widespread: more patients receiving hydroxyethyl starch experienced kidney failure. Previous studies on different starches have also identified kidney problems 2.
市场上有许多种不同类型的羟乙基淀粉，一些医生质疑，仅研究其中一种是否适用于其他淀粉类液体。此外还不清楚关于脓毒症的调查结果会不会影响对其他病症的治疗，特别是监护室以外的使用 — — 如手术室等。但是NEJM 这篇文章说明这个问题是普遍存在的：很多病人输注淀粉后出现肾功衰竭。以前也有研究报道不同的淀粉类液体导致肾功出现问题。
Fluid situation
淀粉类液体使用现状
Leading ICU doctors and researchers are sharply divided on the safety and efficacy of starches. Some had stopped using starches even before the NEJM paper was published. Others insist that the latest developments are far from a death knell for the therapy.
ICU 医生和研究人员就淀粉安全性和疗效分成两派。一派是坚决停止使用淀粉，甚至在新英格兰论文发表之前就停止使用了。另一派坚持认为，最新药物的发展使淀粉不至于成为治疗的丧钟。奈杰尔 · 韦伯斯特是英国皇家医学会重症医学组主席，他坚持使用此药，即使有研究论文为借鉴。他说： 输注淀粉的病人比输注盐水的病人使用更多的血浆等血制品，结果会不同。
Some doctors may be cautious about Perner's results owing to commotion in the community about a decade ago, when a meta-analysis 3 linked the use of the blood-plasma protein albumin as a replacement fluid to increased deaths, before a major study 4 in Australia showed that the result was probably not reliable. The scare has made people wary of changing their practices rapidly in response to similar claims, says Webster.
一些医生可能对朴尼的研究结果持谨慎态度，归咎于10年前的一场学术骚 乱。当时的循证meta分析，认为 使用血浆蛋白作为置换液能增加死亡率，之前澳大利亚的一份研究结果也认为这是不可靠的。 韦伯斯特说，这种恐惧使人们危言耸听，对待相似的说法，就会很快改变行医策略。
“The battle for finding the appropriate replacement fluid has been going on for decades, ” says Clifford Deutschman, a critical-care doctor and researcher at the University of Pennsylvania in Philadelphia. Evidence that starches may be causing harm, he says, “is one more step back in terms of finding it”.
费城宾夕法尼亚大学的研究员克利福德 · 多伊奇曼，同样是一个危重病医生，说：“几十年来，人们一直在寻找合适的置换液。"证据表明，淀粉类液体可能会造成伤害，他说，"就为了找它而言，现在又后退了一步"。朴尼将前往美国 参加 FDA 9 月6-7日的会议 ，研究者们会听到他关于淀粉研究报告，和其他有关淀粉的主要研究报告。在澳大利亚悉尼，由乔治全球健康研究所主导的针对晶体与羟基-乙基淀粉的试验研究（CHEST），观察了 7000 余例澳大利亚监护室病人，比较淀粉与盐水的效果。研究结果即将面世。宾夕法尼亚州匹兹堡大学医学院的危重病医生德里克 · 安格斯认为，结果肯定是这样的，最重要的是CHEST的研究方向与NEJM论文一致。
页:
[1]