|
|
人血白蛋白在多发伤患者治疗中应用时机的探讨
|
Abstract:
人血白蛋白是一种重要的血浆补充物。它在多发伤患者的治疗中发挥着重要作用，可以维持血容量、血压和血浆蛋白质浓度的平衡，防止组织水肿和休克的发生。然而，人血白蛋白在多发伤患者治疗中的应用时机存在争议，具体使用的适应症尚不明确。但人血白蛋白的应用时机不同，对多发伤患者产生的疗效也不一样。近年来，多发伤患者休克早期目标导向治疗(EGDT)方案成为国内外争议的热点，专家们对其看法不一，但其强调的尽早改善组织低灌注的核心思想仍具有重要的指导地位。“尽早”是多早？尽早的“液体”又有哪些选择？尽早添加胶体是否值得推荐？目前学术界对此尚无统一结论，本文结合近期进展对上述问题进行探讨。基于此，考察人血白蛋白的应用时机在多发伤患者治疗中的临床疗效。本文通过查阅相关文献以及分析目前的研究成果，探讨人血白蛋白在多发伤患者治疗中的应用时机，以期为相关临床工作提供参考。
Human blood albumin is an important plasma supplement. It plays an important role in the treat-ment of patients with multiple injuries, maintaining the balance of blood volume, blood pressure and plasma protein concentration, and preventing the occurrence of tissue edema and shock. How-ever, the application timing of human blood albumin in the treatment of patients with multiple in-juries is controversial, and the specific indications for its use are still unclear. However, the applica-tion time of human blood albumin is different, and the effect on patients with multiple injuries is also different. In recent years, the early goal-directed therapy (EGDT) program for shock in patients with multiple injuries has become a hot topic at home and abroad, and experts have different opin-ions on it, but the core idea of improving tissue hypoperfusion as soon as possible is still an im-portant guiding position. How early is “as soon as possible”? What are the options for early “liquid”? Is the early addition of colloids recommended? At present, there is no unified conclusion in the ac-ademic circle. This paper discusses the above problems based on the recent progress. Based on this, the clinical effect of the application time of human blood albumin in the treatment of patients with multiple injuries was investigated. By referring to relevant literature and analyzing the current re-search results, this paper discusses the application time of human blood albumin in the treatment of patients with multiple injuries, so as to provide reference for related clinical work.
| [1] | 殷菲, 刘云, 沈勰. 严重多发伤患者预后的影响因素研究及列线图模型的建立和优化[J]. 中国全科医学, 2022, 25(20): 2498-2506. |
| [2] | 杨帆, 包程蓉, 徐怡琼, 等. 目标导向液体治疗的临床研究进展[J]. 上海医学, 2023, 46(3): 188-191. |
| [3] | 吴华, 程娟. 人血白蛋白在危重患者中应用的荟萃分析[J]. 中国药房, 2010, 21(44): 4140-4143. |
| [4] | Bone, R.C., et al. (1992) Definitions for Sepsis and Organ Failure and Guidelines for the Use of In-novative Therapies in Sepsis. Chest Journal, 101, 1644-1655. https://doi.org/10.1378/chest.101.6.1644 |
| [5] | 辛传伟, 孙云峰, 叶佐武. 危重患者使用人血白蛋白有效性及安全性的Meta分析[J]. 浙江医学, 2014(13): 1168-1171. |
| [6] | 欧阳生珀, 童荣生. 人血白蛋白的合理应用概述[J]. 中国医院药学杂志, 2021, 41(4): 425-429. |
| [7] | 刘媛媛, 张雅鑫, 冀召帅, 等. 基于国内外指南分析某院外科住院患者人血清白蛋白临床使用情况[J]. 中国药业, 2022, 31(3): 124-127. |
| [8] | de Mattos, ？.Z., Simonetto, D.A., Terra, C., Farias, A.Q., Bittencourt, P.L., Pase, T.H.S., Toazza, M.R., de Mattos, A.A. and Alliance of Brazilian Centers for Cirrhosis Care—The ABC Group (2022) Albumin Administration in Patients with Cirrhosis: Current Role and Novel Perspectives. World Journal of Gastroenterology, 28, 4773-4786.
https://doi.org/10.3748/wjg.v28.i33.4773 |
| [9] | 毕立雄. 人血白蛋白对脑出血继发损伤的作用及对相关指标变化的影响[J]. 特别健康, 2020(6): 148. |
| [10] | 王路娜, 钱健, 杨光宇, 等. 依达拉奉联合20%人血白蛋白对危重脑出血患者NIHSS评分及血清cFN SAA表达的干预作用[J]. 河北医学, 2021, 27(2): 217-222. |
| [11] | 周婷, 杨珍, 陆赛花, 刘秀凤, 张晔, 徐峰. 人血白蛋白在危重症患者中临床应用的评价[J]. 药学实践杂志, 2017, 35(2): 167-170. |
| [12] | 霍记平, 李草, 朱斌, 等. 人血白蛋白在住院患者中的临床使用情况调查[J]. 医药导报, 2023, 42(1): 46-52. |
| [13] | Shevtsova, A., Gordiienko, I., Tkachenko, V. and Ushakova, G. (2021) Ischemia-Modified Albumin: Origins and Clinical Implications. Disease Markers, 2021, Article ID: 9945424. https://doi.org/10.1155/2021/9945424 |
| [14] | Silva-Fhon, J.R., Rojas-Huayta, V.M., Aparco-Balboa, J.P., Céspedes-Panduro, B. and Partezani-Rodrigues, R.A. (2021) Sarcopenia and Blood Albumin: A Systematic Review with Meta-Analysis. Biomedica, 41, 590-603.
https://doi.org/10.7705/biomedica.5765 |
| [15] | 胡蕾, 蔡双霜, 唐晓铃, 杨缙. 腹部术后低白蛋白血症患者补充人血白蛋白效果回顾性研究[J]. 中国药业, 2020, 29(14): 81-83. |
| [16] | Kopple, J.D., Cheung, A.K., Christiansen, J.S., Djurhuus, C.B., El Nahas, M., Feldt-Rasmussen, B., Lange, M., Mitch, W.E., Wanner, C., Wiedemann, J. and Ikizler, T.A. (2008) OPPORTUNITY: A Randomized Clinical Trial of Growth Hormone on Outcome in Hemodialysis Patients. Clinical Journal of the American Society of Nephrology, 3, 1741-1751. https://doi.org/10.2215/CJN.02760608 |
| [17] | 胡卓思. 严重胸外伤合并多发伤患者的流行病学特征[D]: [硕士学位论文]. 石家庄: 河北医科大学, 2021. |
| [18] | Stocchetti, N. (2014) Traumatic Brain Injury: Problems and Opportunities. The Lancet Neurology, 13, 14-16.
https://doi.org/10.1016/S1474-4422(13)70280-1 |
| [19] | Jiang, B., Liang, S., Peng, Z.R., et al. (2017) Transport and Public Health in China: The Road to a Healthy Future. The Lancet, 390, 1781-1791. https://doi.org/10.1016/S0140-6736(17)31958-X |
| [20] | 段红杰, 柴家科, 邓虎平. 人血白蛋白的功能及其在危重病治疗中的应用[J]. 解放军医学杂志, 2012, 37(10): 926-929. |
| [21] | Rudd, K.E., Charlotte, J.S., Agesa, K.M., et al. (2020) Global, Regional, and National Sepsis Incidence and Mortality, 1990-2017: Analysis for the Global Burden of Disease Study. The Lancet, 395, 200-211.
https://doi.org/10.1016/S0140-6736(19)32989-7 |
| [22] | 陈鸣, 虞文魁. 人血白蛋白非胶体作用在救治危重症患者中的应用价值[J]. 医学研究生学报, 2021, 34(6): 561-567. |
| [23] | 孙文芳, 李亚利, 成华. 某院人血白蛋白注射液临床应用的药学干预效果评价[J]. 中国合理用药探索, 2022, 19(6): 102-107. |
| [24] | 张琦, 廖瑜, 尚卫华, 等. 多发伤救治体系与损伤控制外科理论在救治严重多发伤患者中的应用[J]. 中国急救复苏与灾害医学杂志, 2014(3): 211-213. https://doi.org/10.3969/j.issn.1673-6966.2014.03.007 |
| [25] | Kremer, H., Baron-Menguy, C., Tesse, A., et al. (2011) Human Serum Albumin Improves Endothelial Dysfunction and Survival during Experimental Endotoxemia: Concentration-Dependent Properties. Critical Care Medicine, 39, 1414-1422.
https://doi.org/10.1097/CCM.0b013e318211ff6e |
| [26] | Jagdish, R.K., Maras, J.S. and Sarin, S.K. (2021) Albumin in Advanced Liver Diseases: The Good and Bad of a Drug! Hepatology, 74, 2848-2862. https://doi.org/10.1002/hep.31836 |
| [27] | Yu, Y.T., Liu, J., Hu, B., et al. (2021) Expert Consensus on the Use of Human Serum Albumin in Critically Ill Patients. Chinese Medical Journal, 134, 1639-1654. https://doi.org/10.1097/CM9.0000000000001661 |
| [28] | 陈敏, 张国伟, 金凤玲, 等. 人血白蛋白临床应用中存在的误区与争议[J]. 海峡药学, 2015, 27(11): 89-91. |
| [29] | 庄云云. 人血白蛋白临床应用分析[J]. 海峡药学, 2019, 31(1): 261-263. |
| [30] | 邓兴旺, 齐旭辉, 杨绍贤, 等. 人血白蛋白在重症烧伤休克早期液体复苏中应用的临床观察[J]. 中华损伤与修复杂志(电子版), 2022, 17(1): 47-53. |
| [31] | 代明盛, 赵伟军, 屠传建. 成立创伤抢救小组在多发伤救治中的临床价值[J]. 浙江创伤外科, 2015(1): 162-164. |
| [32] | 赵资坚, 蔡史健, 张荣臻, 等. 严重骨盆骨折伴多发伤院前院内一体化损伤控制救治模式的建立及临床应用[J]. 中国骨与关节损伤杂志, 2015, 30(6): 561-565. |
| [33] | Vermeulen, L.C., Ratko, T.A., Erstad, B.L., et al. (1995) A Paradigm for Consensus. The University Hospital Consortium Guidelines for the Use of Albumin, Nonprotein Colloid, and Crystalloid Solutions. Archives of In-ternal Medicine, 155, 373-379. https://doi.org/10.1001/archinte.155.4.373 |
| [34] | 王锦权, 刘宝, 陶晓根, 周彩平, 赵劲松, 承韶晖, 吴双正, 杜庆. 连续性血液净化在危重病中应用指征的临床研究[J]. 中国急救医学, 2007, 27(10): 881-884. https://doi.org/10.3969/j.issn.1002-1949.2007.10.006 |
| [35] | Saline or Albumin for Fluid Resusci-tation in Patients with Traumatic Brain Injury: The SAFE Study Investigators. The New England Journal of Medicine, 357, 874-884. https://doi.org/10.1056/NEJMoa067514 |
| [36] | Cooper, D.J., Myburgh, J., Finfer, S., et al. (2913) Albumin Resuscitation for Traumatic Brain Injury: Is Intracranial Hypertension the Cause of Increased Mortality? Jour-nal of Neurotrauma, 30, 512-518.
https://doi.org/10.1089/neu.2012.2573 |
| [37] | Jacob, M., Chappell, D., Conzen, P., et al. (2008) Small-Volume Re-suscitation with Hyperoncotic Albumin: A Systematic Review of Randomized Clinical Trials. Critical Care, 12, Article No. R34. https://doi.org/10.1186/cc6812 |
| [38] | Vincent, J.L., Navickis, R.J. and Wilkes, M.M. (2004) Morbidity in Hospitalized Patients Receiving Human Albumin: A Meta-Analysis of Randomized, Controlled Trials. Critical Care Medicine, 32, 2029-2038.
https://doi.org/10.1097/01.CCM.0000142574.00425.E9 |
| [39] | Picetti, E., Rossi, S., Abu-Zidan, F.M., et al. (2019) WSES Consensus Conference Guidelines: Monitoring and Management of Severe Adult Traumatic Brain Injury Patients with Polytrauma in the First 24 Hours. World Journal of Emergency Surgery, 14, Article No. 53. https://doi.org/10.1186/s13017-019-0270-1 |
| [40] | 林才, 荆国杰, 李王安, 等. 视频回顾对严重多发伤患者规范化接诊与院内救治流程改进效果分析[J]. 中国急救复苏与灾害医学杂志, 2020, 15(3): 323-325. |
| [41] | 王冲. 改良早期预警评分和急性生理和慢性健康评分II对急诊多发伤患者伤情评价及预后预测作用分析[J]. 中文科技期刊数据库(全文版)医药卫生, 2021(3): 26, 28. |
| [42] | 刘建凡, 曹慧. 一体化链式创伤急救护理模式结合预见性创伤护理在多发伤患者急诊救治中的应用效果[J]. 临床医学研究与实践, 2022, 7(2): 160-162. |
| [43] | 廖国强, 方少洪, 何国文, 等. 超敏C反应蛋白与白蛋白比值对经皮肾镜手术后全身炎症反应的预测作用探讨[J]. 微创泌尿外科杂志, 2020, 9(3): 182-185. https://doi.org/10.19558/j.cnki.10-1020/r.2020.03.006 |
| [44] | Lvovschi, V.E., Maignan, M., Tazarourte, K., et al. (2020) Multiple Criteria Decision Analysis Approach to Consider Therapeutic Innovations in the Emergency Department: The Methoxyflurane Organizational Impact in Acute Trauma Pain. PLOS ONE, 15, e0231571. https://doi.org/10.1371/journal.pone.0231571 |
