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出血性休克
患者可因失血 ( 包括红细胞 、 白细胞 、 血小板和血 浆的丢失 ) 出现失血性休克 。 此类患者的主要治疗方法 是通过输注血液成分 ( 包括红细胞 、 血小板 、 血浆和冷
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沉淀 ) 来恢复有效循环容量 。 人血白蛋白是血浆的主 要成分 , 更容易获得并且可以迅速给药 。 因此 , 它可以 快速补充有效循环量 , 增加血压 , 并增加组织灌注 。
因此 , 它是液体复苏的最重要选择之一 。 然而 , 因 出血性休克进行液体复苏时 , 晶体液 ( 平衡液 、 生理盐 水 ) 是首选 , 由于人血白蛋白价格昂贵 , 不推荐在液体 复苏中常规使用人血白蛋白 。 当需要进行限制性液体复 苏时 , 可将 20 % 的人血白蛋白作为扩容剂使用 。
结论
人血白蛋白属天然胶体 , 输注人血白蛋白可增加血 浆胶体渗透压并改善组织水肿 。 同时 , 它还可以增加有 效循环容量 , 改善组织器官的灌注 , 改善器官功能 。 大 多数 ICU 患者具有器官功能障碍 、 低白蛋白血症 、 低血 压和组织水肿 。
本文列举了 ICU 内常见的人血白蛋白输注情况 , 由 于 ICU 患者病情危重且病理生理学复杂 , 变化快 , 因此 , 对于何种患者合适输注人血白蛋白可以最大程度的临床 获益仍然存在争议 。 已经发表的研究原著由于纳入患者 基线水平 , 基础疾病及危重程度的不同 , 亦无法得出统 一的结论 。 因此使用过程中仍需要密切的临床观察 , 并 在条件许可情况下开展大样本多中心的 RCT 研究以期得 到明确的答案 。
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