HPE Chinese Human albumin handbook - Page 29

剂硫醇依赖性能力以及蛋白质氧化损伤水平具有积极
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作用 。 观察数据表明 , 对于重症登革热患儿 , 20 % 的人血白蛋白溶液与 5 % 人血白蛋白溶液治疗相比 , 具 有更高的乳酸清除率 ( 一种复苏充分性的有效替代指
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标 ), 且机械通气 、 ICU 住院时间和住院时间更短 。 已对 ALI 患者进行了提高呼气末正压压力 、 高张
人血白蛋白小剂量复苏以及速尿或超滤用于液体清除
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的组合试验 。 与配对对照相比 , 接受这种联合治疗方 法的患者的累积液体平衡 、 血管外肺水指数和腹内压 均获得了降低 。 临床结果也得到了改善 , 即 ICU 住院 与机械通气的天数减少 , 28 天的死亡率降低 , 无器官
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功能受损 。 在使用速尿清除液体时 , 利尿剂抵抗可能取决于低
白蛋白血症的严重程度 , 而低白蛋白血症本身可能是人
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血白蛋白溶液与速尿之间相互作用的重要影响因素 。 需要进行进一步的研究 , 以评估是否可开展速尿压力试
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验 。 严重的低白蛋白血症还会阻碍肾小管腔内速尿的 分泌 , 导致利尿剂抵抗 , 而速尿与高张人血白蛋白溶液 同时给药可克服抵抗 。
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合并低白蛋白血症的患者 , 肺生理功能有所改善 , 每 种药物的单独效应尚不清楚 。
此外 , 对于 ALI 患者 , 白蛋白治疗对血浆抗氧化
结论
液体管理是 ARF 循证治疗的主要手段 。 低血容量 症是休克发展因素 , 然这一因素易被纠正 。 但是 , 重症 患者通常会出现液体累积正平衡 , 并且与不良结局相 关 , 在 ARDS 中尤其如此 。 人血白蛋白溶液是安全的 , 并且有助于达到液体负平衡 。 此外 , 低白蛋白血症是抗 生素治疗失败 、 需要机械通气以及社区获得性呼吸道感 染转归的预测性因素 。 目前的最佳证据支持在 ARF 的限 制性液体管理中使用人血白蛋白溶液 , 而同时血清白蛋 白水平的提升可能会带来其他益处 。
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