HPE Chinese Human albumin handbook - Page 28

白蛋白溶液以纠正低白蛋白血症 , 相比生理盐水该治疗 增加了术中尿量并降低了不停跳冠状动脉搭桥手术后的
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AKI 发生风险 。
在两名感染性休克患者的皮肤中 , 在接受生理盐水 或 20 % 人血白蛋白输注前后 , 乙酰胆碱离子电泳微循环 血流测量结果证实了输注白蛋白可改善感染性休克患者
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内皮功能的观点 。 总之 , 纠正低白蛋白血症和改善内皮功能以及改善
肾脏功能可以解释输注白蛋白对重症手术和非手术患者
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的血流动力学和体液平衡的有益作用 。 对于接受静 脉 - 动脉 ECMO ( VA- ECMO ) 治疗的患者 , 正如在单 中心 ICU 的回顾性登记研究中所观察到的 , 这些作用机 制可能会转化为存活率的提高 。 对于接受过平衡液 ( n = 171 ) 与人血白蛋白及平衡液 1 : 2 混合液 ( n = 112 ) 进 行液体复苏 , 置管后 12 小时液体正平衡的 VA-ECMO 患
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者 , 使用过白蛋白治疗的患者存活率显著提高 。
液体负平衡
临床检查 、 床边工具和影像学检查结果可用于评估 重症患者的液体状态 , 检测液体超负荷并及时清除液体 ; 连续管理中最常用的策略是液体平衡 。 重症患者中常见的 液体正平衡会导致较差结果 , 尤其是在脓毒症 、 ARDS 和 AKI 中 。 人们正在研究限制性输液和主动清除积聚的液
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体的方法 , 将之作为预防和治疗液体超负荷手段 。 在这种情况下 , 在限制性液体复苏的不同阶段使用
人血白蛋白溶液的研究越来越多 。 在对少尿或无尿患者加大利尿剂剂量之前 , 或当利
尿剂反应不充分时 , 应使用 RRT 46 。 速尿是 ICU 中最常
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用的利尿剂 。 对于急性肺损伤 ( ALI )/ ARDS 且血清 总蛋白水平 < 6.0g / d 的机械通气患者 , 与安慰剂对比 , 速尿与人血白蛋白溶液联合使用 72 小时 , 根据输液量
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进行滴定并标准化血清总蛋白 。 可显著增加氧合 , 提
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升血清总蛋白与净液体排出量 。 事实上 , 较早的一项 研究表明 , 经人血白蛋白溶液和速尿治疗的 ALI / ARDS
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