容量復(fù)蘇中明膠安全性的薈萃分析ppt課件

1、容量復(fù)蘇中明膠安全性的薈萃分析容量復(fù)蘇中明膠安全性的薈萃分析2013年年1月月23日日1;.ContentsContentsIntroductionMethodsResultsConclusion2IntroductionIntroductionn動(dòng)物膠原的降解產(chǎn)物n平均分子量為60-80 kDa n因凝點(diǎn)高于室溫n所以這種明膠未應(yīng)用于臨床n1915年，對(duì)明膠進(jìn)行首次驗(yàn)證nHogan J. JAMA 1915;64:721-726n但這種明膠難以滅菌n凝點(diǎn)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. Jacobson

2、S and Smyth C. Arch Int Med Arch Int Med 1944;74:254-2471944;74:254-247n通過(guò)水解作用保持其流動(dòng)性n二戰(zhàn)期間應(yīng)用于50例患者n成功復(fù)蘇n1951年首次報(bào)道Campbell, Koepfli, Pauling Campbell, Koepfli, Pauling et al. Tex Rep Biol Med et al. Tex Rep Biol Med 1951;9:235-2801951;9:235-280n肽類通過(guò)乙二醛相互交聯(lián)n分子量介于10-40 kDa之間n現(xiàn)已廢棄n1962年首次報(bào)道Schmidt-Thome,

3、 Mager, Schmidt-Thome, Mager, Schne. Schne. Arzneimittelforschung Arzneimittelforschung 1962;12:378-3801962;12:378-380 n牛骨明膠經(jīng)熱降解而成n分子量介于5-50 kDan1955年首次報(bào)道nTourtelotte 5th International Congress of Blood Transfusion 1955:950-953n小牛皮膠原經(jīng)熱降解而成n氨基被羧基替代n負(fù)電荷使分子撐開(kāi)以增加空間結(jié)構(gòu)3IntroductionIntroductionGenerally, g

4、elatin 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, 10.4IntroductionIntroductionPerel et al. 13 compared gelatin to crystalloid fluids in 506 critically

5、ill adult patientsBunn et al. 15 compared gelatin with albumin or PPF in 636 patients thought to need volume replacement.5IntroductionIntroductionNo review found a significant effect on mortality. However, effects on renal function or blood product use were not systematically explored.6MethodsMethod

6、sEligibility 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 for resus-citation(5) at least one intervention group receivedgelatin solution(6)

7、 at least one intervention groupreceived another resuscitation fluid7MethodsMethodsExclusion criteria (1) only volunteers or blood donors were recruited(2) administration of fluid was solely for the purpose of volume preloading before anesthesia including volume loading for neural block , acute norm

8、ovolemic 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 results published in a language other than English, German, French, or Italian.8M

9、ethodsMethodsSearch strategyOvid Medline(1948May 2011)EMBASE (1947May 2011)Cochrane Central Register of Controlled Trials (CEN-TRAL) (through May 2011)9MethodsMethodsData analysisSPSS 17.0random-effects model (Rev Man 5.1, Cochrane Collaboration)10ResultsResults11ResultsResults12ResultsResults13Resu

10、ltsResults14ResultsResults1516ResultsResults17ResultsResults18ResultsResults19DiscussionDiscussionsynthetic colloidsImprecise resultLittle research Critically ill patients20ConclusionConclusionGelatins 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