Emili S, Black N A, Paul R V, Rexing C J, Ullian M E
Division of Nephrology and the Hemodialysis Unit, Medical University of South Carolina, Charleston, SC, USA.
Am J Kidney Dis. 1999 Jun;33(6):1107-14. doi: 10.1016/S0272-6386(99)70148-4.
Human serum albumin is used in hemodialysis (HD) units as treatment for hypotension despite its high cost and undetermined efficacy. During a 4-month period in 1995, albumin was used in 22% of 1,296 consecutive HD treatments in the HD unit or intensive care units (ICUs) at our tertiary-care hospital. We evaluated the safety and efficacy of a protocol designed to minimize albumin use for treating HD-associated hypotension (HDAH). The protocol consisted of the stepwise use of saline, mannitol, and albumin for the purpose of achieving physician-determined ultrafiltration goals. Patients were exempted from receiving the protocol for age younger than 18 years, freshly declotted angioaccess, or cardiovascular instability. The protocol was evaluated prospectively in 2,559 consecutive dialysis sessions (15% in ICUs) in 442 patients. Hypotension occurred during 608 sessions (24%), and attending nephrologists elected to initiate the protocol in 71% of these cases. Of the 433 instances in which the protocol was begun, reversal of hypotension was achieved without the need for albumin in 91% and with the addition of albumin in an additional 2%. Protocol treatment was not completed because of nursing error in 1% or clotting of filter or angioaccess in 4%. Use of the protocol failed to reverse hypotension in only 2% of the cases in which it was completed. Albumin was administered in only 6% of the 2,559 HD treatments. In summary, our protocol-based approach to HDAH was effective, easy for nurses to use, albumin sparing, and cost reducing.
尽管人血清白蛋白成本高昂且疗效尚未确定，但仍被用于血液透析（HD）单位以治疗低血压。在1995年的4个月期间，在我们三级护理医院的HD单位或重症监护病房（ICU）中，1296次连续HD治疗中有22%使用了白蛋白。我们评估了一项旨在尽量减少使用白蛋白治疗HD相关低血压（HDAH）的方案的安全性和有效性。该方案包括逐步使用生理盐水、甘露醇和白蛋白，以实现医生确定的超滤目标。年龄小于18岁、新近解凝的血管通路或心血管不稳定的患者可免于接受该方案。该方案在442例患者的2559次连续透析治疗（15%在ICU）中进行了前瞻性评估。608次治疗（24%）期间发生了低血压，主治肾病专家在其中71%的病例中选择启动该方案。在开始该方案的433例中，91%在无需白蛋白的情况下实现了低血压逆转，另有2%添加了白蛋白后实现逆转。由于护理失误，1%的方案治疗未完成，4%是由于滤器或血管通路凝血。在完成方案治疗的病例中，仅2%未能逆转低血压。在2559次HD治疗中，仅6%使用了白蛋白。总之，我们基于方案的HDAH治疗方法有效、护士易于使用、节省白蛋白且降低成本。
