白蛋白与生理盐水在脓毒症相关外周组织低灌注中的应用：一项概念验证性前瞻性研究。
Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study.
机构信息
Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, Paris, France.
出版信息
Crit Care. 2024 Feb 7;28(1):43. doi: 10.1186/s13054-024-04827-0.
BACKGROUND
Albumin has potential endothelial protective effects through antioxidant and anti-inflammatory properties. However, the effect of albumin on peripheral tissue perfusion in human sepsis remains poorly known.
METHODS
Bi-centric prospective study included patients with sepsis with or without shock and prolonged CRT > 3 s despite initial resuscitation. Clinicians in charge of the patients were free to infuse either saline 500 mL or human serum albumin 20% 100 mL over 15 min. Global hemodynamic parameters as well as peripheral tissue perfusion were analyzed after 1 (H1) and 4 h (H4). The primary endpoint was CRT normalization (< 3 s) at H1.
RESULTS
62 patients were screened, and 50 patients (13 sepsis and 37 septic shock) were included, 21 in the saline group and 29 in the albumin group. SOFA score was 8 [5-11], and SAPS II was 53 [45-70]. Median age was 68 [60-76] years with a higher proportion of men (74%). The primary sources of infection were respiratory (54%) and abdominal (24%). At baseline, comorbidities, clinical and biological characteristics were similar between groups. At H1, CRT normalization (< 3 s) was more frequent in patients receiving albumin as compared to patients treated by saline (63 vs 29%, P = 0.02). The decrease in fingertip CRT was more important in the albumin group when compared to saline group (- 1.0 [- 0.3; - 1.5] vs - 0.2 [- 0.1; - 1.1] seconds, P = 0.04) as well as decrease in mottling score. At H4, beneficial effects of albumin on peripheral tissue perfusion were maintained and urinary output trended to be higher in the albumin group (1.1 [0.5-1.8] vs 0.7 [0.5-0.9] ml/kg/h, P = 0.08). Finally, arterial lactate level did not significantly change between H0 and H4 in the saline group but significantly decreased in the albumin group (P = 0.03).
CONCLUSION
In patients with resuscitated sepsis, albumin infusion might lead to greater improvement of tissue hypoperfusion compared to saline.
CLINICALTRIALS
gov Identifier: NCT05094856.
背景
白蛋白具有抗氧化和抗炎特性，因此具有潜在的内皮保护作用。然而，白蛋白对人类脓毒症外周组织灌注的影响仍知之甚少。
方法
这是一项双中心前瞻性研究，纳入了伴有或不伴有休克且持续 CRT ＞ 3s 的复苏后脓毒症患者。负责患者的临床医生可自由选择在 15 分钟内输注生理盐水 500ml 或人血清白蛋白 20% 100ml。在 1 小时（H1）和 4 小时（H4）后分析整体血流动力学参数和外周组织灌注情况。主要终点为 H1 时 CRT 正常化（＜3s）。
结果
共筛选了 62 例患者，其中 50 例（13 例脓毒症和 37 例脓毒性休克）入选，其中生理盐水组 21 例，白蛋白组 29 例。SOFA 评分为 8[5-11]，SAPS II 为 53[45-70]。中位年龄为 68[60-76]岁，男性比例较高（74%）。主要感染源为呼吸道（54%）和腹部（24%）。基线时，各组的合并症、临床和生物学特征相似。在 H1 时，与生理盐水组相比，接受白蛋白治疗的患者 CRT 正常化（＜3s）更为常见（63% vs 29%，P=0.02）。与生理盐水组相比，白蛋白组指尖 CRT 下降更为显著（-1.0[-0.3；-1.5] vs -0.2[-0.1；-1.1]s，P=0.04），斑点评分下降也更为显著。在 H4 时，白蛋白对周围组织灌注的有益作用仍得以维持，且白蛋白组的尿量趋于更高（1.1[0.5-1.8] vs 0.7[0.5-0.9]ml/kg/h，P=0.08）。最后，生理盐水组在 H0 至 H4 期间动脉血乳酸水平无显著变化，但白蛋白组显著下降（P=0.03）。
结论
在复苏后脓毒症患者中，与生理盐水相比，白蛋白输注可能会导致组织灌注不足的改善更为显著。
临床试验
gov 标识符：NCT05094856。
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