危重病手术患者输注晶体与胶体后发病率和死亡率的比较：随机试验的亚组分析
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Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients：A Subgroup Analysis of a Randomized Trial
背景与目的
本研究为多中心随机试验，旨在探讨重症监护病房低血容量休克的危重病人(CRISTAL)复苏过程中胶体和晶体晶体的使用对患者的临床结局影响是否存在差异
方 法
危重患者的标准定为：在重症监护病房入院前或入院后24小时内接受紧急或择期手术并伴低血容量休克。主要的测量指标是28天内死亡情况。次要指标包括90天内死亡情况、是否需要肾脏替代治疗或输注新鲜冷冻血浆输血等。
结 果
危重患者741例，其中晶体组356例，胶体组385例。年龄中位数为66岁(52岁至76岁)，484名(65.3%)患者为男性。543例(73.3%)未手术。到第28天，晶体组死亡84例(23.6%)和胶体组死亡100例(26%)，死亡率没有显著差异;调整优势比（0.86;95%CI：0.61 ~ 1.21;P = 0.768)。90天死亡情况(111例[31.2%]对122 例[31.7%]);调整优势比0.97;95% CI： 0.70-1.33;P = 0.919),各组间差异无统计学意义。晶体组42例(11.8%)患者需要肾脏替代治疗，胶体组49例(12.7%)患者需要肾脏替代治疗(P = 0.871)。
结 论
本研究表明晶体和胶体的使用对危重患者生存率无明显影响
原始文献摘要
Nicholas Heming, Laure Lamothe, Samir Jaber,etal;Morbidity and Mortality of Crystalloids Compared toColloids in Critically Ill Surgical Patients:A Subgroup Analysis of a Randomized Trial;Anesthesiology 2018; 129:1149-58
Background: The multicenter randomized Colloids versus Crystalloids for the Resuscitation of the Critically Ill (CRISTAL) trial was designed to test whether colloids altered mortality compared to crystalloids in the resuscitation of intensive care unit patients with hypovolemic shock. This preplanned analysis tested the same hypothesis in the subgroup of surgical patients.
Methods: The CRISTAL trial prospectively defined patients as critically ill surgical patients whenever they underwent emergency or scheduled surgery immediately before or within 24 h of intensive care unit admission and had hypovolemic shock. The primary outcome measure was death by day 28. Secondary outcome measures included death by day 90, the need for renal replacement therapy, or the need for fresh frozen plasma transfusion.
Results: There were 741 critically ill surgical patients, 356 and 385 in the crystalloid and colloid arm, respectively. Median (interquartile range) age was 66 (52 to 76) yr, and 484 (65.3%) patients were male. Surgery was unscheduled in 543 (73.3%) cases. Mortality by day 28 did not significantly differ for crystalloids 84 (23.6%) versus colloids 100 (26%; adjusted odds ratio, 0.86; 95% CI, 0.61 to 1.21; P = 0.768). Death by day 90 (111 [31.2%] vs. 122 [31.7%]; adjusted odds ratio, 0.97; 95% CI, 0.70 to 1.33; P = 0.919) did not significantly differ between groups. Renal replacement therapy was required for 42 (11.8%) patients in the crystalloids arm versus 49 (12.7%) in the colloids arm (P = 0.871).
Conclusions: The authors found no survival benefit when comparing crystalloids to colloids in critically ill surgical patients.
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