ヒドロキシエチルデンプン
Hydroxyethyl Starch (HES)
Hydroxyethyl Starch
別名: Hespan · Hextend · Voluven · Hetastarch · Tetrastarch · Pentastarch · Etherified starches
VetSheet 獣医チームが監修更新日 2026年4月5日エビデンスに基づく獣医学リファレンス
用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。
動物種別用量
🌎 NA — North America🌍 EU — Europe
犬
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| Shock bolus (resuscitation) | 10-20 mL/kg | IV | once | — | 🌎 NA |
| Infusion | 1-2 mL/kg/hr; not to exceed 20 mL/kg in a 24 hour period | IV | CRI | 24 hours | 🌎 NA |
| Emergent situations / Colloid oncotic pressure support | 20 mL/kg /day | IV | slow bolus over 15-30 minutes OR 24-hour infusion | — | 🌎 NA |
| Shock resuscitation | 20 mL/kg | IV | bolus | — | 🌎 NA |
- Shock bolus (resuscitation): Rate determined by patient requirements.
- Emergent situations / Colloid oncotic pressure support: For supporting colloid oncotic pressure in hypoalbuminemic patients, give as a 24-hour infusion with low-rate crystalloids.
- Shock resuscitation: Standard dose. Patients may have elevations in PT and aPTT without evidence of bleeding.
猫
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| Shock bolus (resuscitation) | 5-10 mL/kg | IV | once | — | 🌎 NA |
| Infusion | 1-2 mL/kg/hr; not to exceed 10 mL/kg in a 24 hour period | IV | CRI | 24 hours | 🌎 NA |
| Emergent situations / Colloid oncotic pressure support | 10/mL/kg/day | IV | slow bolus over 15-30 minutes OR 24-hour infusion | — | 🌎 NA |
| Shock resuscitation | 20 mL/kg | IV | bolus | — | 🌎 NA |
- Shock bolus (resuscitation): Administer slower than in dogs to avoid nausea/vomiting.
- Shock resuscitation: Slower in the cat. Rapid administration to cats can cause nausea and vomiting.
小型哺乳類
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| Camelids - Volume expansion | 15 mL/kg | IV | once | — | 🌎 NA |
- Camelids - Volume expansion: Significantly increased COP for up to 96 hours. Transient mild hemodilution and mild increases in PT/PTT noted.
鳥
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| Volume replacement | 10-15 mL/kg over 20-40 minutes, up to four times daily, OR 10-15 mL/kg bolus over 20-40 minutes followed by 1-2 mL/kg/hr continuous rate infusion | IV | up to q6h or CRI | — | 🌎 NA |
| Small volume replacement/CPCR resuscitation | 3-5 mL/kg over 5 min | IV | once | — | 🌎 NA |
| Volume replacement | 3-5 mL/kg IV or IO over 10 minutes, one to two boluses | IV/IO | 1-2 boluses | — | 🌎 NA |
- Volume replacement: Recommended maximum dose is 20 mL/kg/24 hours, though author notes exceeding this without side effects.
- Small volume replacement/CPCR resuscitation: Given after hypertonic saline (3-5 mL/kg). Follow with crystalloids and repeat every 15-20 mins until stable.
馬
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| Adult horses - volume support | 8-10 mL/kg/day | IV | daily | — | 🌎 NA |
| Foals - rapid volume support | 3-5 mL/kg | IV | once | — | 🌎 NA |
| Hypo-oncotic, well hydrated horses | 0.5-1 mL/kg per hour, up to 10 mL/kg/day | IV | CRI | — | 🌎 NA |
| Volume replacement | 3-10 mL/kg | IV | once | — | 🌎 NA |
| Fluid resuscitation and management of hypoproteinemia | 8-10 mL/kg IV bolus or as a CRI at 0.5-1 mL/kg/hr (max. of 10 mL/kg/day) | IV | bolus or CRI | — | 🌎 NA |
- Foals - rapid volume support: In addition to crystalloids.
- Volume replacement: Total daily doses of 10 mL/kg should not be exceeded due to risk for coagulopathies.
用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。
概要
ヒドロキシエチルデンプン (HES) は、主にアミロペクチンから構成されるワキシーコーンスターチ由来の合成コロイド血漿増量剤です。獣医療の救急集中治療において、循環血液量減少の治療および膠質浸透圧の維持に使用されます。
主な臨床的特徴:
- 血管内貯留性: 晶質液と比較して、HESはより優れ、かつ持続的な血管内血漿増量効果をもたらします。
- 毛細血管漏出症候群: 全身性炎症を伴う患者において、血管透過性を低下させ、炎症性メディエーターを抑制するのに役立ちます。
- 分子量と置換度: 製品は平均分子量 (MW) と置換度 (DS) によって分類されます（例: HES 450/0.7、HES 130/0.4）。MWとDSが高いほど血管内半減期は延長しますが、血液凝固異常のリスクが高まります。
作用機序
HES acts as a synthetic colloid to expand plasma volume through oncotic forces.
- Oncotic Pull: Large HES molecules remain in the intravascular space → increase plasma oncotic pressure → draw fluid from the interstitial space into the blood vessels → expand circulating blood volume.
- Enzymatic Degradation: To prevent rapid breakdown, the glucose units of amylopectin are substituted with hydroxyethyl ether groups.
- Metabolism: Larger molecules are slowly degraded by serum alpha-amylase into smaller fragments → fragments < 50,000 Daltons are rapidly excreted by the kidneys.
安全性・警告
禁忌
- Severe heart failure
- Severe bleeding disorders
- Oliguric or anuric renal failure
有害事象
- Coagulopathies (prolonged PT/PTT, altered Factor VIII and von Willebrand Factor)
- Nausea and vomiting (especially in cats if administered too rapidly)
- Volume overload leading to pulmonary edema
- Hypersensitivity/anaphylactic reactions (rare)
- Falsely elevated serum amylase levels
- Transient increases in indirect serum bilirubin
- Potential risk for acute kidney injury (extrapolated from human data)
注意事項
Important Warnings & Precautions:
- Coagulation: HES can precipitate Factor VIII and interfere with von Willebrand Factor. Use with extreme caution in patients with pre-existing coagulopathies (e.g., von Willebrand's disease), thrombocytopenia, or those undergoing CNS surgery.
- Renal Risk: Human data suggests a risk of acute kidney injury (AKI), particularly in septic patients. Use cautiously in veterinary patients with pre-existing renal dysfunction or sepsis.
- Volume Overload: Can cause severe circulatory overload. Use with caution in patients with congestive heart failure (CHF), oliguric renal failure, or pulmonary edema.
- Capillary Leak: In severe sepsis, SIRS, or trauma, HES may extravasate into the pulmonary interstitium, potentially causing or worsening pulmonary edema.
- Administration in Cats: Rapid IV boluses in cats frequently cause nausea and vomiting; administer slowly (over 15-30 minutes).
- Not a Blood Substitute: HES has no oxygen-carrying capacity and does not replace the need for RBCs in anemic patients.
医薬品相互作用
Do not administer Hextend simultaneously with blood through the same administration set due to a risk of coagulation.
監視
- Fluid status (blood pressure, heart rate, capillary refill time, central venous pressure)
- Coagulation parameters (PT, PTT, platelet count), especially in high-risk patients or with high doses
- Clinical signs of pulmonary edema (respiratory rate/effort, lung auscultation)
- Blood gases
- Renal function (BUN, creatinine, urine output)
薬物動態
吸収
Immediate volume expansion following intravenous administration. Maximum volume expansion occurs within a few minutes of the completion of infusion.
分布
Remains primarily within the intravascular space to exert oncotic pressure. In patients with severe capillary leak, it may extravasate into interstitial spaces.
代謝
Larger molecules (>50,000 Daltons) are slowly degraded enzymatically by serum amylase to a size where they can be excreted.
消失
Lower molecular weight molecules (<50,000 Daltons) are rapidly excreted by the kidneys. About 40% of a dose is excreted in the first 24 hours. Practically all the drug is excreted after about 2 weeks.
過剰投与
Overdosage primarily results in intravascular volume overload, which can lead to pulmonary edema and congestive heart failure in susceptible patients. Treatment involves stopping the infusion, carefully monitoring fluid status, and administering diuretics (e.g., furosemide) if pulmonary edema develops.
製品
製剤
- 6% HES (450/0.7) in 0.9% sodium chloride (Hespan)
- 6% HES (670/0.75) in lactated electrolyte (Hextend)
- 6% HES (130/0.4) in 0.9% sodium chloride (Voluven)
ヒト用医薬品
- Hetastarch Injection: 6% (6 g/100 mL) HES (450/0.7) in 0.9% sodium chloride (Hespan)
- Hetastarch Injection: 6% (6 g/100 mL) HES (670/0.75) in lactated electrolyte (Hextend)
- Tetrastarch Injection: 6% (6 g/100 mL) HES (130/0.4) in 0.9% sodium chloride (Voluven)
規制ステータス
規制データなし: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
保管・安定性
Store at temperatures less than 40°C (104°F); freezing should be avoided. Exposure to temperature extremes may result in the formation of a crystalline precipitate or a color change to a turbid deep brown. Do not use if this occurs.
飼主向け情報
飼い主向け情報:
- ICUでの救急使用: ヒドロキシエチルデンプン (HES) は、通常、集中治療室 (ICU) などの院内環境でのみ使用される静脈内輸液です。
- 使用目的: これは「コロイド」輸液であり、通常の点滴よりも長く血管内に留まる大きな分子を含んでいます。ショック、危険な低血圧、または重度のタンパク質喪失を迅速に治療するために使用されます。
- モニタリング: 強力な輸液であるため、体液過多（呼吸に影響を与える可能性があります）や血液凝固の変化の兆候がないか、ペットは注意深く監視されます。
- 費用: コロイド療法とそれに伴う集中的なモニタリングは、救急治療の費用を大幅に増加させる可能性があります。獣医師が、ペットの容態安定のためにこの治療が必要な具体的な理由をご説明します。
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