Foley E F, Borlase B C, Dzik W H, Bistrian B R, Benotti P N
Department of Surgery, Harvard University Medical School, New England Deaconess Hospital, Boston, Mass.
Arch Surg. 1990 Jun;125(6):739-42. doi: 10.1001/archsurg.1990.01410180063012.
Albumin replacement to correct hypoalbuminemia in critically ill patients has been controversial. This study was a prospective, randomized trial of 25% albumin administration in 40 hypoalbuminemic (serum albumin, less than 25 g/L [2.5 g/dL]), critically ill patients. The treatment group (18 patients) received 25% albumin supplementation to achieve and maintain serum albumin levels of 25 g/L (2.5 g/dL) or greater, while the nontreatment group (22 patients) received no concentrated albumin. There was no clinical benefit from albumin therapy when assessing mortality (39% vs 27%, treatment vs control) or major complication rate (89% vs 77% of patients). There were also no significant differences in length of hospital stay, intensive care unit stay, ventilator dependence, or tolerance of enteral feeding, despite significant elevations of albumin in the treatment group. The costly use of exogenous albumin as treatment for hypoalbuminemia in this patient population does not appear to be justified.
在危重症患者中，使用白蛋白替代疗法纠正低白蛋白血症一直存在争议。本研究是一项前瞻性随机试验，对40例低白蛋白血症（血清白蛋白低于25g/L[2.5g/dL]）的危重症患者给予25%白蛋白。治疗组（18例患者）接受25%白蛋白补充治疗，以使血清白蛋白水平达到并维持在25g/L（2.5g/dL）或更高，而未治疗组（22例患者）未接受浓缩白蛋白治疗。在评估死亡率（治疗组与对照组分别为39%和27%）或主要并发症发生率（患者分别为89%和77%）时，白蛋白治疗没有临床益处。尽管治疗组白蛋白水平显著升高，但在住院时间、重症监护病房住院时间、呼吸机依赖或肠内营养耐受性方面也没有显著差异。在这类患者人群中，将昂贵的外源性白蛋白用于治疗低白蛋白血症似乎并无正当理由。
