再谈人血白蛋白在重症患者中的应用.pptVIP

2003年的另一项系统评价比较了HSA和晶体液、不使用HSA、低剂量HSA的疗效，共纳入79项随机对照研究，包括4755例患者，结果显示：与晶体液相比，HSA可降低心脏手术、非心脏手术、腹水等患者的并发症发生率，且含HSA的治疗方案可改善脑损伤患者的预后。 Albumin administration: what is the evidence of clinical benefit? A systematic review of randomized controlled trials. Eur J Anaesthesiol, 2003, 20(10): 771-9. 第三十一页，共55页 Vincent等对接受HSA治疗的重症住院患者进行了一项随机对照研究的荟萃分析，发现HSA可显著降低危重病患者的整体并发症发生率(RR=0.92，95%CI 0.86～0.98)，且并发症的发生率与HSA的使用剂量显著相关(P=0.002)。 Morbidity in hospitalized patients receiving human albumin: a meta-analysis of randomized, controlled trials. Crit Care Med, 2004, 32(10):2029-2038. 第三十二页，共55页 The SAFE Study Investigators A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med,2004; 350: 2247- 2256?? 第三十三页，共55页 SAFE STUDY We randomly assigned patients who had been admitted to the ICU to receive either 4 percent albumin or normal saline for intravascular-fluid resuscitation during the next 28 days. Of the 6997 patients who underwent randomization, 3497 were assigned to receive albumin and 3500 to receive saline; the two groups had similar baseline characteristics. The primary outcome measure was death from any cause during the 28-day period after randomization. 第三十四页，共55页 There were 726 deaths in the albumin group, as compared with 729 deaths in the saline group (relative risk of death, 0.99; 95 percent confidence interval, 0.91 to 1.09; P=0.87). SAFE STUDY 第三十五页，共55页 The proportion of patients with new single-organ and multiple-organ failure was similar in the two groups (P=0.85). There were no significant differences between the groups in the mean (±SD) numbers of days spent in the ICU (6.5±6.6 in the albumin group and 6.2±6.2 in the saline group, P=0.44), days spent in the hospital (15.3±9.6 and 15.6±9.6, respectively; P=0.30), days of mechanical ventilation (4.5±6.1 and 4.3±5.7, respectively; P=0.74), or days of renal-replacement therapy (0.5±2.3 and 0.4±2.0, respectively; P=0.41). SAFE STUDY 第三十六页，共55页 SAFE 第三十七页，共55页 对2002 年5 月1