人血白蛋白给药对蛛网膜下腔出血患者临床结局和住院费用的影响。
Effect of human albumin administration on clinical outcome and hospital cost in patients with subarachnoid hemorrhage.
作者信息
Suarez Jose I, Shannon Larry, Zaidat Osama O, Suri Muhammad F, Singh Grwant, Lynch Gwendolyn, Selman Warren R
机构信息
Neurosciences Critical Care, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106, USA.
出版信息
J Neurosurg. 2004 Apr;100(4):585-90. doi: 10.3171/jns.2004.100.4.0585.
OBJECT
Human albumin is used to induce hypervolemia (central venous pressure [CVP] > 8 mm Hg) after subarachnoid hemorrhage (SAH). Unfortunately, human albumin may increase the mortality rate in critically ill patients; because of this, its use became restricted in the authors' hospital in May 1999. The goal of this study was to determine the effect of human albumin on outcome and cost in patients with SAH before and after this restriction was put into place.
METHODS
All patients with aneurysmal SAH who were admitted to the authors' institution between May 1998 and May 2000 were studied. Basic demographic information, dosage of human albumin given, length of stay, and the incidence of in-hospital deaths and complications were collected. The authors obtained Glasgow Outcome Scale (GOS) scores at 3 months after SAH (good outcome, GOS > or = 4). Data were analyzed using t-test and chi-square analysis. Logistic regression was used to identify independent associations between use of human albumin and outcome. The authors studied 140 patients: 63 who were admitted between May 1998 and May 1999 (Group 1) and 77 treated between June 1999 and May 2000 (Group 2). Two subgroups of patients were further analyzed. Group 1 patients who received human albumin (albumin subgroup, 37 patients) and Group 2 patients who would have received albumin under the old protocol (that is, those who failed to achieve CVP > 8 mm Hg after normal saline administration; nonalbumin subgroup, 47 patients). Patients in the nonalbumin subgroup were more likely to be male (38% compared with 16%), to experience hypertension (55% compared with 30%), to suffer from hypomagnesemia (49% compared with 5.4%), and to have hydrocephalus (47% compared with 27%). There was a trend for these patients to have more vasospasm (28% compared with 19%, p = 0.2). Patients in the albumin subgroup were more likely to have a good outcome at 3 months.
CONCLUSIONS
Administration of human albumin after SAH may improve clinical outcome and reduce hospital cost.
目的
蛛网膜下腔出血（SAH）后使用人血白蛋白诱导高血容量（中心静脉压[CVP]＞8 mmHg）。遗憾的是，人血白蛋白可能会增加重症患者的死亡率；因此，自1999年5月起作者所在医院限制了其使用。本研究的目的是确定在实施这一限制前后，人血白蛋白对SAH患者的预后及费用的影响。
方法
对1998年5月至2000年5月间入住作者所在机构的所有动脉瘤性SAH患者进行研究。收集基本人口统计学信息、人血白蛋白给药剂量、住院时间以及院内死亡和并发症的发生率。作者在SAH后3个月获得格拉斯哥预后量表（GOS）评分（良好预后，GOS≥4）。采用t检验和卡方分析对数据进行分析。使用逻辑回归确定人血白蛋白的使用与预后之间的独立关联。作者研究了140例患者：63例于1998年5月至1999年5月入院（第1组），77例于1999年6月至2000年5月接受治疗（第2组）。对两组患者进一步分析两个亚组。第1组中接受人血白蛋白的患者（白蛋白亚组，37例）和第2组中按照旧方案本应接受白蛋白治疗的患者（即生理盐水给药后CVP未达到＞8 mmHg的患者；非白蛋白亚组，47例）。非白蛋白亚组的患者男性比例更高（38%对比16%）、高血压发生率更高（55%对比30%）、低镁血症发生率更高（49%对比5.4%）、脑积水发生率更高（47%对比27%）。这些患者发生血管痉挛的趋势更明显（28%对比19%，p = 0.2）。白蛋白亚组的患者在3个月时预后良好的可能性更大。
结论
SAH后给予人血白蛋白可能改善临床预后并降低住院费用。
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