人血白蛋白在危重症患者中临床应用的评价
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摘要
目的评价重症监护病房(ICU)人血白蛋白(human serum albumin,HSA)合理使用情况,促进HSA的合理应用。方法收集2015年1月1日至2015年12月31日ICU使用HSA患者信息,对HSA使用情况进行统计分析,评价使用的合理性。结果 64例患者使用HSA共计416支,平均用量62.5g;使用HSA主要原因为低蛋白血症(39.1%),其次为脑水肿、颅脑外伤、各型休克及恶性肿瘤等。使用HSA前,患者血清白蛋白水平在25~35g/L的占35.9%,15~25g/L的占56.3%。结论 ICU的HSA使用广泛,涉及多种用途,但存在超适应证使用等不合理使用情况。呼吁相关部门尽快出台HSA使用指南,促使各医疗机构规范使用。
Objective To evaluate the utilization of human serum albumin(HSA)in intensive care unit(ICU)to promote rational use of HSA clinically.Methods Data were collected from the patients received HSA therapy during the period of January 1,2015 to December 31,2015.The indications and usage of HSA were analyzed statistically.Results 416 bottles of HSA were administered to 64 patients.The average dose was 62.5g per patient.The most popular indication was for hypoproteinemia(39.1%)followed by encephaledema,craniocerebral trauma,shock and tumors.Before the HSA therapy,36patients(56.3%)had albumin level of 15-25g/L and 23patients(35.9%)of 25-35g/L.Conclusion HSA is widely used in ICU for different indications.Some misuses still exist.Guidelines for proper use of HSA are needed to guarantee its rational use.HSA should be used strictly following these guidelines.
Objective To evaluate the utilization of human serum albumin(HSA)in intensive care unit(ICU)to promote rational use of HSA clinically.Methods Data were collected from the patients received HSA therapy during the period of January 1,2015 to December 31,2015.The indications and usage of HSA were analyzed statistically.Results 416 bottles of HSA were administered to 64 patients.The average dose was 62.5g per patient.The most popular indication was for hypoproteinemia(39.1%)followed by encephaledema,craniocerebral trauma,shock and tumors.Before the HSA therapy,36patients(56.3%)had albumin level of 15-25g/L and 23patients(35.9%)of 25-35g/L.Conclusion HSA is widely used in ICU for different indications.Some misuses still exist.Guidelines for proper use of HSA are needed to guarantee its rational use.HSA should be used strictly following these guidelines.
引文
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[14]Gou Y,Yang F,Liang H.Designing prodrugs based on special residues of human serum albumin[J].Curr Top Med Chem,2016,16(9):996-1008.
[15]王丹,陈慧,刘丽宏,等.172例人血清蛋白临床应用合理性调查与分析[J].药学实践杂志,2014,32(3):231-234.
[16]Ting YX,Wang B.Investigation and analysis of human serum albumin clinical utilization[J].Chin pharm J,2010,45(13):1035-1038.
[17]Roberts I,Blackhall K,Alderson P,et al.Human albumin solution for resuscitation and volume expansion in critically ill patients[J].Cochrane Database Syst Rev,2011,(11):CD001208.
[18]Saw MM,Chandler B,Ho KM.Benefits and risks of using gelatin solution as a plasma expander for perioperative and critically ill patients:a meta-analysis[J].Anaesth Intensive Care,2012,40(1):17-32.
[19]Pulimood TB,Park GR.Debate:Albumin administration should be avoided in the critically ill[J].Crit Care,2000,4(3):151-155.
[20]Finfer S,Bellomo R,Boyce N,et a1.A comparison of albumin and saline for fluid resuscitation in the intensive care unit[J].N Engl J Med,2004,350(22):2247-2256.
[2]Mendez CM,McClain CJ,Marsano LS.Albumin therapy in clinical practice[J].Nutr Clin Pract,2005,20(3):314-320.
[3]Liberati A,Moja L,Moschetti I,et al.Human albumin solution for resuscitation and volume expansion in critically ill patients[J].Intern Emerg Med,2006,1(3):243-245.
[4]Vincent JL.Resuscitation using albumin in critically ill patients:research in patients at high risk of complications is now needed[J].BMJ,2006,333(7577):1029-1030.
[5]Zhou T,Lu SH,Liu XF,et al.,Review of the rational use and adverse reactions to human serum albumin in the People′s Republic of China[J].Patient Prefer Adherence,2013,7:1207-1212.
[6]Vincent JL,Wilkes MM,Navickis RJ.Safety of human albumin—serious adverse events reported worldwide in 1998-2000[J].Br J Anaesth,2003,91(5):625-630.
[7]Sikuler E,Shapira A,Mor-Yosef S,et al.Rational use of albumin[J].Harefuah,2000,139(5-6):190-193,246.
[8]Vermeulen LC Jr,Ratko TA,Erstad BL,et al.A paradigm for consensus.The University Hospital Consortium guidelines for the use of albumin,nonprotein colloid,and crystalloid solutions[J].Arch Intern Med,1995,155(4):373-379.
[9]Suarez JI,Martin RH,Calvillo E,et al.The albumin in subarachnoid hemorrhage(ALISAH)multicenter pilot clinical trial:safety and neurologic outcomes[J].Stroke,2012,43(3):683-690.
[10]赵龙姝,雷鸣,时扣荣,等.不同浓度人血白蛋白对老年脑出血危重患者的疗效研究[J].临床急诊杂志,2015,16(5):373-375.
[11]Perel P,Roberts I.Colloids versus crystalloids for fluid resuscitation in critically ill patients[J].Cochrane Database Syst Rev,2011(3):CD000567.
[12]Caironi P,Langer T,Gattinoni L.Albumin in critically ill patients:the ideal colloid[J].Curr Opin Crit Care,2015,21(4):302-308.
[13]Takahashi I,Ohnuma T,Kavy S,et al.Interaction of human serum albumin with anticancer agents in vitro[J].Br J Cancer,1980,41(4):602-608.
[14]Gou Y,Yang F,Liang H.Designing prodrugs based on special residues of human serum albumin[J].Curr Top Med Chem,2016,16(9):996-1008.
[15]王丹,陈慧,刘丽宏,等.172例人血清蛋白临床应用合理性调查与分析[J].药学实践杂志,2014,32(3):231-234.
[16]Ting YX,Wang B.Investigation and analysis of human serum albumin clinical utilization[J].Chin pharm J,2010,45(13):1035-1038.
[17]Roberts I,Blackhall K,Alderson P,et al.Human albumin solution for resuscitation and volume expansion in critically ill patients[J].Cochrane Database Syst Rev,2011,(11):CD001208.
[18]Saw MM,Chandler B,Ho KM.Benefits and risks of using gelatin solution as a plasma expander for perioperative and critically ill patients:a meta-analysis[J].Anaesth Intensive Care,2012,40(1):17-32.
[19]Pulimood TB,Park GR.Debate:Albumin administration should be avoided in the critically ill[J].Crit Care,2000,4(3):151-155.
[20]Finfer S,Bellomo R,Boyce N,et a1.A comparison of albumin and saline for fluid resuscitation in the intensive care unit[J].N Engl J Med,2004,350(22):2247-2256.