히드록시에틸 전분
Hydroxyethyl Starch (HES)
Hydroxyethyl Starch
다른 이름: Hespan · Hextend · Voluven · Hetastarch · Tetrastarch · Pentastarch · Etherified starches
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
소형 포유류
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
히드록시에틸 전분(HES)은 주로 아밀로펙틴으로 구성된 찰옥수수 전분에서 유래한 합성 콜로이드 혈장 증량제입니다. 수의 응급 중환자 치료에서 저혈량증을 치료하고 교질 삼투압을 유지하는 데 사용됩니다.
주요 임상적 특징:
- 혈관 내 지속성: 정질액(Crystalloid)에 비해 더 우수하고 지속적인 혈관 내 용적 확장 효과를 제공합니다.
- 모세혈관 누출 증후군: 전신 염증 환자에서 혈관 투과성을 감소시키고 전염증성 매개물질을 하향 조절하는 데 도움을 줄 수 있습니다.
- 분자량 및 치환도: 제품은 평균 분자량(MW)과 치환도(DS)에 따라 분류됩니다(예: HES 450/0.7, HES 130/0.4). MW와 DS가 높을수록 혈관 내 반감기가 길어지지만 응고 장애의 위험이 증가합니다.
작용 기전
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.
안전성·주의사항
금기사항
- Severe heart failure
- Severe bleeding disorders
- Oliguric or anuric renal failure
부작용
- 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)
주의
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.
약물 상호작용
Do not administer Hextend simultaneously with blood through the same administration set due to a risk of coagulation.
모니터링
- 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)
약동학
흡수
Immediate volume expansion following intravenous administration. Maximum volume expansion occurs within a few minutes of the completion of infusion.
분포
Remains primarily within the intravascular space to exert oncotic pressure. In patients with severe capillary leak, it may extravasate into interstitial spaces.
대사
Larger molecules (>50,000 Daltons) are slowly degraded enzymatically by serum amylase to a size where they can be excreted.
배설
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.
과다투여
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.
제품
제형
- 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)
인용의약품
- 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)
규제 현황
규제 데이터 없음: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
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.
보호자 정보
반려동물 보호자 안내:
- 응급 중환자실(ICU) 사용: 히드록시에틸 전분(HES)은 일반적으로 집중 치료실(ICU)과 같은 병원 환경에서만 사용되는 정맥 수액입니다.
- 사용 목적: 이 수액은 '콜로이드' 수액으로, 일반 정맥 수액보다 혈관 내에 더 오래 머무르는 큰 분자를 포함하고 있습니다. 쇼크, 위험할 정도의 저혈압 또는 심각한 단백질 손실을 신속하게 치료하는 데 사용됩니다.
- 모니터링: 강력한 수액이므로 체액 과부하(호흡에 영향을 줄 수 있음) 및 혈액 응고 변화의 징후가 있는지 반려동물을 면밀히 모니터링하게 됩니다.
- 비용: 콜로이드 치료와 이에 필요한 집중적인 모니터링은 응급 치료 비용을 크게 증가시킬 수 있습니다. 수의사가 반려동물의 상태 안정을 위해 이 치료가 필요한 구체적인 이유를 설명해 드릴 것입니다.
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