容量复苏中明胶安全性的荟萃分析

1、容量复苏中明胶安全性的荟萃分析容量复苏中明胶安全性的荟萃分析2013年年1月月23日日整理pptContentsContentsIntroductionMethodsResultsConclusion整理pptIntroductionIntroductionn动物胶原的降解产物n平均分子量为60-80 kDa n因凝点高于室温n所以这种明胶未应用于临床n1915年，对明胶进行首次验证nHogan J. JAMA 1915;64:721-726n但这种明胶难以灭菌n凝点高于室温n由于分子量大于100,000道尔顿，因此粘稠度大n5%明胶溶液nJacobson S and Smyth C. Arc

2、h Int Med Jacobson S and Smyth C. Arch Int Med 1944;74:254-2471944;74:254-247n通过水解作用保持其流动性n二战期间应用于50例患者n成功复苏n1951年首次报道Campbell, Koepfli, Pauling et al. Tex Rep Campbell, Koepfli, Pauling et al. Tex Rep Biol Med 1951;9:235-280Biol Med 1951;9:235-280n肽类通过乙二醛相互交联n分子量介于10-40 kDa之间n现已废弃n1962年首次报道Schmidt-

3、Thome, Mager, Schne. Schmidt-Thome, Mager, Schne. Arzneimittelforschung 1962;12:378-380Arzneimittelforschung 1962;12:378-380 n牛骨明胶经热降解而成n分子量介于5-50 kDan1955年首次报道nTourtelotte 5th International Congress of Blood Transfusion 1955:950-953n小牛皮胶原经热降解而成n氨基被羧基替代n负电荷使分子撑开以增加空间结构整理pptIntroductionIntroductionGe

4、nerally, 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.整理pptIntroductionIntroductionPerel et al. 13 compared gelatin to crystalloid fluids in 5

5、06 critically ill adult patientsBunn et al. 15 compared gelatin with albumin or PPF in 636 patients thought to need volume replacement.整理pptIntroductionIntroductionNo review found a significant effect on mortality. However, effects on renal function or blood product use were not systematically explo

6、red.整理pptMethodsMethodsEligibility 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 recei

7、vedgelatin solution(6) at least one intervention groupreceived another resuscitation fluid整理pptMethodsMethodsExclusion 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

8、 neural block , acute normovolemic or hypervolemic hemodilution without subsequent intra- or postoperative use(3)retracted studies 16(., other synthetic colloids (as those may have similar risk profile)(5) study results published in a language other than English, German, French, or Italian.整理pptMeth

9、odsMethodsSearch strategyOvid Medline(1948May 2011)EMBASE (1947May 2011)Cochrane Central Register of Controlled Trials (CEN-TRAL) (through May 2011)整理pptMethodsMethodsData analysisSPSS random-effects model (Rev Man 5.1, Cochrane Collaboration)整理pptResultsResults整理pptResultsResults整理pptResultsResults

10、整理pptResultsResults整理pptResultsResults整理ppt整理pptResultsResults整理pptResultsResults整理pptResultsResults整理pptDiscussionDiscussionsynthetic colloidsImprecise resultLittle research Critically ill patients整理pptConclusionConclusionGelatins 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 t