Natsch S, van Leeuwen S J, de Jong R, Hekster Y A
Department of Clinical Pharmacy, University Hospital Nijmegen, The Netherlands.
J Clin Pharm Ther. 1998 Jun;23(3):179-83. doi: 10.1046/j.1365-2710.1998.00134.x.
There are two main reasons for hypo-albuminaemia in severely ill patients: long-lasting malnutrition and metabolic response to stress. Hypo-albuminaemia is therefore a prognostic indicator of illness severity rather than a cause of disease. Supplementation with albumin has not yet been demonstrated to have measurable therapeutic effects. Hypovolaemia is often seen in intensive care unit (ICU) patients, either postoperatively or caused through shock. The main goal of any treatment is to maintain adequate intravascular filling. No clear benefit can be seen when using albumin instead of artificial colloids.
Based on the literature, we performed an intervention study to evaluate and improve the use of albumin.
After evaluation of the use of albumin over the last 4 years (by means of analysis of the pharmacy drug use statistics), all staff members of the ICU were invited to discuss information retrieved from recently published literature. This led to the introduction of the following new guidelines. Albumin may only be given to patients with very low serum albumin levels of less than 15 g/litre. Substitution of albumin between levels of 15-20 g/litre may take place if patients are in poor condition. The indication has to be documented in the patient's notes.
After the introduction of the guidelines, the use of albumin dropped by more than 50% from 3178 units in 1996 to 1565 units in 1997. This led to direct cost savings of approximately US$100000.
The available literature about the risks and benefits of using albumin in clinical practice is not conclusive. The use of albumin should therefore be restricted according to the guidelines.
重症患者发生低白蛋白血症主要有两个原因：长期营养不良和对压力的代谢反应。因此，低白蛋白血症是疾病严重程度的预后指标而非病因。补充白蛋白尚未被证明具有可测量的治疗效果。低血容量在重症监护病房（ICU）患者中很常见，可发生于术后或由休克引起。任何治疗的主要目标都是维持足够的血管内充盈。使用白蛋白而非人工胶体时未见明显益处。
基于文献，我们进行了一项干预研究以评估并改进白蛋白的使用。
在评估过去4年白蛋白的使用情况（通过分析药房用药统计数据）后，邀请ICU的所有工作人员讨论从近期发表的文献中获取的信息。这导致引入了以下新指南。白蛋白仅可给予血清白蛋白水平极低（低于15克/升）的患者。如果患者情况较差，白蛋白水平在15 - 20克/升之间时可进行替代治疗。必须在患者病历中记录适应证。
引入指南后，白蛋白的使用量从1996年的3178单位降至1997年的1565单位，降幅超过50%。这直接节省了约10万美元的成本。
关于在临床实践中使用白蛋白的风险和益处的现有文献尚无定论。因此，应根据指南限制白蛋白的使用。
