目标:如今,人们普遍认为白蛋白不应用于低蛋白血症或营养目的。目前讨论最多的白蛋白指征是休克状态下的复苏,尤其是分布性休克,如感染性休克。主要的循证指征也是肝病。在这次审查中,我们为临床实践中白蛋白给药的明确和潜在指征提供了最新的循证指导,适当的剂量和持续时间。
方法:通过搜索包括PubMed在内的电子数据库,进行了数据收集,直到2023年11月。谷歌学者,Scopus,和WebofScience。等级系统已用于确定每个白蛋白适应症的证据质量和建议强度。
结果:本综述共纳入165项相关研究。血浆置换和肝脏疾病的液体置换,包括肝肾综合征,自发性细菌性腹膜炎,和大体积穿刺,有中等到高质量的证据,并强烈建议使用白蛋白。此外,白蛋白用作低血容量性休克液体复苏的二线和辅助晶体,脓毒症和脓毒性休克,严重烧伤,中毒性表皮坏死松解症,透析中低血压,卵巢过度刺激综合征,大手术,非创伤性脑损伤,体外膜氧合,急性呼吸窘迫综合征,严重和难治性水肿伴低蛋白血症的证据质量低到中等,推荐使用也很弱。此外,在适度体积的穿刺中,肝硬化患者重度低钠血症的证据质量低到中度,推荐量也较弱.
结论:白蛋白给药是治疗肝硬化并发症的最有效方法。液体复苏或严重和难治性水肿的治疗,尤其是低蛋白血症和对其他治疗没有反应的患者,是白蛋白的另一种合理用途。在医院实施循证指南可以成为减少白蛋白不当使用的有效措施。
OBJECTIVE: Nowadays, it is largely accepted that albumin should not be used in hypoalbuminemia or for nutritional purpose. The most discussed indication of albumin at present is the resuscitation in shock states, especially distributive shocks such as septic shock. The main evidence-based indication is also liver disease. In this review, we provided updated evidence-based instruction for definite and potential indications of albumin administration in clinical practice, with appropriate dosing and duration.
METHODS: Data collection was carried out until November 2023 by search of electronic databases including PubMed, Google Scholar, Scopus, and Web of Science. GRADE system has been used to determine the quality of evidence and strength of recommendations for each albumin indication.
RESULTS: A total of 165 relevant studies were included in this review. Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin. Moreover, albumin is used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory
edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use. Also, in modest volume paracentesis, severe hyponatremia in cirrhosis has a low to moderate quality of evidence and a weak recommendation.
CONCLUSIONS: Albumin administration is most indicated in management of cirrhosis complications. Fluid resuscitation or treatment of severe and refractory
edema, especially in patients with hypoalbuminemia and not responding to other treatments, is another rational use for albumin. Implementation of evidence-based
guidelines in hospitals can be an effective measure to reduce inappropriate uses of albumin.