HPE Chinese Human albumin handbook - Page 21

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
34
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 。
References 1 Ferrer R et al . Non-oncotic properties of albumin . A multidisciplinary vision about the implications for critically ill patients . Expert Rev Clin Pharmacol 2018 ; 11 ( 2 ): 125 – 37 . 2 Caraceni P et al . Clinical indications for the albumin use : still a controversial issue . Eur J Intern Med 2013 ; 24 ( 8 ): 721 – 8 . 3 Estébanez-Montiel MB et al . Results of a survey on albumin use in clinical practice in intensive care units . Med Intensiva 2014 ; 38 ( 7 ): 403 – 12 . 4 Rhodes A et al . Surviving Sepsis Campaign : International Guidelines for Management of Sepsis and Septic Shock : 2016 . Crit Care Med 2017 ; 45 ( 3 ): 486 – 552 . 5 Finfer S et al . A comparison of albumin and saline for fluid resuscitation in the intensive care unit . N Engl J Med 2004 ; 350 ( 22 ): 2247 – 56 . 6 Patel A et al . Randomised trials of human albumin for adults with sepsis : systematic review and meta-analysis with trial sequential analysis of all-cause mortality . BMJ 2014 ; 349 : g4561 . 7 Rochwerg B et al . Fluid resuscitation in sepsis : A systematic review and meta-analysis . Ann Intern Med 2014 ; 161:347 – 55 . 8 Wiedermann C , Joannidis M . Albumin replacement in severe sepsis or septic shock . N Engl J Med 2014 ; 371 ( 1 ): 83 . 9 Caironi P et al . ALBIOS Study Investigators : Albumin replacement in patients with severe sepsis or septic shock . N Engl J Med 2014 ; 370:1412 – 21 . 10 Xu JY et al . Comparison of the effects of albumin and crystalloid on mortality in adult patients with severe sepsis and septic shock : a meta-analysis of randomized clinical trials . Crit Care 2014 ; 18:702 . 11 Charpentier J , Mira J-P . Efficacy and tolerance of hyperoncotic albumin administration in septic shock patients : the EARSS study . Intensive Care Med 2011 ; 37 : Suppl 1 : S115 . 12 Park CH et al . Lactated Ringer ’ s versus 4 % albumin on lactated Ringer ’ s in early sepsis therapy in cancer patients : A pilot single-center randomized trial . Crit Care Med 2019 ; 47 ( 10 ): e798-e805 . 13 Kittisakmontri K , Reungrongrat S , Lao-Araya M . Hypoalbuminaemia at admission predicts the poor outcomes in critically ill children . Anaesthesiol Intensive Ther 2016 ; 48 ( 3 ): 158 – 61 . 14 Ha CE , Bhagavan NV . Novel insights into the pleiotropic effects of human serum albumin in health and disease . Biochim Biophys Acta 2013 ; 1830:5486 – 93 . 15 Caraceni P et al . Long-term albumin administration in decompensated cirrhosis ( ANSWER ): an open-label randomised trial . Lancet 2018 ; 391 ( 10138 ): 2417 – 29 . 16 Bernardi M et al . Albumin infusion in patients undergoing
large-volume paracentesis : a meta-analysis of randomized trials . Hepatology 2012 ; 5 ( 4 ): 1172 – 81 . 17 Moreau R et al . Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid : a randomised controlled pilot trail . Liver Int 2006 ; 26:46 – 54 . 18 Boyer TD et al . Terlipressin plus albumin is more effective than albumin alone in improving renal function in patients with cirrhosis and hepatorenal syndrome type 1 . Gastroenterology 2016 ; 150 ( 7 ): 1579 – 1589 ( e1572 ). 19 Forasassi C et al . Inflammation and disability as risk factors for mortality in elderly acute care patients . Arch Gerontol Geriatr 2009 ; 48 ( 3 ): 406 – 10 . 20 Zhang WH et al . Risk factors and survival outcomes for postoperative pulmonary complications in gastric cancer patients . Hepatogastroenterology 2015 ; 62 ( 139 ): 766 – 72 . 21 Dubois MJ et al . Albumin administration improves organ function in critically ill hypoalbuminemic patients : A prospective , randomized , controlled , pilot study . Crit Care Med 2006 ; 34:2536 – 40 . 22 Chinese Society of Hepatology , Chinese Medical Association . Chinese guidelines on the management of ascites and its related complications in cirrhosis . Hepatol Int 2019 ; 13 ( 1 ): 1 – 21 . 23 Sort P et al . Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis . N Engl J Med 1999 ; 341:403 – 9 . 24 Bernardi M et al . Role of human albumin in the management of complications of liver cirrhosis . J Clin Exp Hepatol 2014 ; 4:302 – 11 . 25 Banares R et al . Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure : the RELIEF trial . Hepatology 2013 ; 57:1153 – 62 . 26 Kribben A et al . Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure . Gastroenterology 2012 ; 142:782 – 9 . 27 Hessel F et al . Costeffectiveness of the artificial liver support system MARS in patients with acute-on-chronic liver failure . Eur J Gastroenterol Hepatol 2010 ; 22:213 – 20 . 28 Zhou YT et al . Acute spontaneous intracerebral hemorrhage and traumatic brain injury are the most common causes of critical illness in the ICU and have high early mortality . BMC Neurol 2018 ; 18 ( 1 ): 127 . 29 Carney N et al . Guidelines for the management of severe traumatic brain injury , Fourth Edition . Neurosurgery 2017 ; 80 ( 1 ): 6 – 15 . 30 Navickis RJ , Greenhalgh DG , Wilkes MM . Albumin in burn
shock resuscitation : A meta-analysis of controlled clinical studies . J Burn Care Res 2016 ; 37 ( 3 ): e268 – e278 . 31 Gattinoni L , Cressoni M , Brazzi L . Fluids in ARDS : from onset through recovery . Curr Opin Crit Care 2014 ; 20 ( 4 ): 373 – 7 . 32 Yao L et al . Efficacy of 20 % albumin infusion on coagulation and pulmonary fibrosis in rabbits with ARDS . Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 ; 29 ( 5 ): 407 – 12 . 33 Martin GS et al . A randomized , controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury . Crit Care Med 2005 ; 33 ( 8 ): 1681 – 7 . 34 Gupta B et al . Vasopressors : Do they have any role in hemorrhagic shock ? J Anaesthesiol Clin Pharmacol 2017 ; 33 ( 1 ): 3 – 8 .
hospitalpharmacyeurope . com | 2020 | 21