Sapijaszko M J, Brant R, Sandham D, Berthiaume Y
Department of Medicine, University of Calgary, Canada.
Crit Care Med. 1996 Apr;24(4):601-7. doi: 10.1097/00003246-199604000-00009.
To determine the role of serum albumin concentration as a predictor of mechanical ventilation dependency.
Prospective, observation trial.
Multidisciplinary intensive care unit (ICU) in a university hospital.
One hundred forty-five consecutive patients who required mechanical ventilation for > 72 hrs.
Patients were classified into five different groups based on the cause of respiratory failure. The following parameters were recorded daily: serum albumin concentration; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; and fluid balance. Using multiple regression, multiple logistic regression analysis, and the Anderson-Gill proportional hazards model, we determined the metabolic factors that could help predict weaning success.
The mean length of ICU stay was 12.3 +/- 1.0 days. The duration of mechanical ventilation dependency was 10.5 +/- 1.0 days. The initial mean serum albumin concentration was 25.2 +/- 0.6 g/L. The APACHE II score on the first day of ICU stay was 19.1 +/- 0.6. Although albumin concentration was significantly lower and the APACHE II score was significantly higher in ICU nonsurvivors than in ICU survivors, albumin concentration on ICU admission was not a predictor of the length of time spent receiving mechanical ventilation. The profile of albumin concentration changes was different between weaned and mechanical ventilation-dependent patients. At the time of weaning patients from the ventilator, the median albumin concentration was higher than in those patients who continued to be supported by mechanical ventilation. This effect of albumin could not be attributed to patient fluid balance or to the severity of illness since each factor had an independent influence in predicting weaning, using the Anderson-Gill proportional hazards models.
Initial serum albumin concentration did not necessarily predict weaning success. However, when serum albumin concentration was assessed on a daily basis, its trend was important in determining the relative chance of being successfully weaned from the ventilator. This finding suggests that albumin may be an index of the metabolic status of the patient, which could be important in determining the weanability of the patients who are mechanically ventilated for prolonged periods of time.
确定血清白蛋白浓度作为机械通气依赖预测指标的作用。
前瞻性观察试验。
大学医院的多学科重症监护病房（ICU）。
145例连续接受机械通气超过72小时的患者。
根据呼吸衰竭病因将患者分为五个不同组。每天记录以下参数：血清白蛋白浓度；急性生理与慢性健康状况评分系统II（APACHE II）评分；以及液体平衡。使用多元回归、多元逻辑回归分析和安德森-吉尔比例风险模型，我们确定了有助于预测撤机成功的代谢因素。
ICU平均住院时间为12.3±1.0天。机械通气依赖持续时间为10.5±1.0天。初始血清白蛋白平均浓度为25.2±0.6 g/L。入住ICU第一天的APACHE II评分为19.1±0.6。虽然ICU非幸存者的白蛋白浓度显著低于幸存者，且APACHE II评分显著高于幸存者，但入住ICU时的白蛋白浓度并非机械通气时间长短的预测指标。撤机患者与机械通气依赖患者的白蛋白浓度变化情况不同。在撤机时，患者的白蛋白浓度中位数高于继续接受机械通气的患者。使用安德森-吉尔比例风险模型，白蛋白的这种作用不能归因于患者的液体平衡或疾病严重程度，因为每个因素在预测撤机方面都有独立影响。
初始血清白蛋白浓度不一定能预测撤机成功。然而，当每日评估血清白蛋白浓度时，其变化趋势对于确定成功撤机的相对可能性很重要。这一发现表明，白蛋白可能是患者代谢状态的一个指标，这对于确定长时间接受机械通气患者的撤机可能性可能很重要。
