白蛋白与平衡晶体液的早期应用对重症脓毒症患者液体复苏作用及预后的影响  

Effect of early application of albumin and balanced crystalloid solution on fluid resuscitation and prognosis in patients with severe sepsis

作　　者：金少峰 衣晓娜 金雨虹[1] 丁毅[1] 金栋材 Jin Shaofeng;Yi Xiaona;Jin Yuhong;Ding Yi;Jin Dongcai(Department of Serious Medicine,Li Huili Hospital,Ningbo Medical Center,Ningbo 315040,China)

机构地区：[1]宁波市医疗中心李惠利医院重症医学科,宁波315040

出　　处：《国际流行病学传染病学杂志》2024年第3期164-168,共5页International Journal of Epidemiology and Infectious Disease

基　　金：浙江省医药卫生科技计划(2023KY1044)。

摘　　要：目的探究白蛋白与平衡晶体液的早期应用对重症脓毒症患者的液体复苏作用及预后的影响。方法纳入2021年10月至2022年8月在宁波市医疗中心李惠利医院就诊的80例重症脓毒症患者, 采取单盲、随机数字表法将患者分为对照组(40例)和观察组(40例), 两组均给予早期液体复苏治疗, 对照组给予复方氯化钠注射液, 观察组在对照组基础上给予白蛋白。比较两组临床指标、复苏前后血流动力学指标、28 d病死率和30 d内重大肾脏不良事件发生率。结果观察组ICU入住时间、住院时间和48 h液体总平衡分别为(3.05±0.55)d、(10.30±1.32)d和(287.73±115.33)mL, 均低于对照组(t=2.19, P=0.031;t=5.61, P<0.001;t=23.56, P<0.001);复苏72 h后, 观察组患者心率为(74.23±7.00)次/min, 低于对照组;平均动脉压和心脏指数分别为(61.34±6.21)mmHg(1 mmHg=0.133 kPa)和(2.24±0.37)L·min^(-1)·m^(-2), 均高于对照组, 差异均有统计学意义(t=6.44、-6.50和-3.82, 均P<0.001)。观察组28 d病死率为12.50%(5/40), 低于对照组(χ^(2)=4.58, P=0.032)。观察组与对照组30 d内重大肾脏不良事件发生率分别为57.50%(23/40)和60.00%(24/40), 差异无统计学意义(χ^(2)=0.05, P=0.820)。结论白蛋白与平衡晶体液的早期应用可缩短重症脓毒症患者液体复苏后的住院时间, 维持患者液体平衡, 改善患者液体复苏后的血流动力学, 降低患者液体复苏后的病死率, 且具有良好的安全性。Objective To explore the effect of early application of albumin and balanced crystalloid solution on fluid resuscitation and prognosis of patients with severe sepsis.Methods A total of 80 patients with severe sepsis admitted to Li Huili Hospital,Ningbo Medical Center from October 2021 to August 2022 were included,and were divided into the control group(40 cases)and the observation group(40 cases)by single-blind random number table method.Both groups received early fluid resuscitation therapy,with the control group receiving compound sodium chloride injection and the observation group receiving albumin in addition to the treatment in the control group.Clinical indicators,hemodynamics before and after resuscitation,28-day mortality,and incidence of severe adverse renal events within 30 days were compared between the two groups.Results The intensive care unit(ICU)stay time,hospital stay time and 48-hour total fluid balance in the observation group were(3.05±0.55)d,(10.30±1.32)d and(287.73±115.33)mL,which were significantly lower than those in the control group(t=2.19,P=0.031;t=5.61,P<0.001;t=23.56,P<0.001).After 72 hours of resuscitation,the observation group had a lower heart rate of(74.23±7.00)beats/min,and higher mean arterial pressure and cardiac index of(61.34±6.21)mmHg(1 mmHg=0.133 kPa)and(2.24±0.37)L^(-1)·min^(-1)·m^(-2),respectively,which had statistically significant differences with the control group(t=6.44,-6.50,and-3.82,all P<0.001).The 28-day mortality rate in the observation group was 12.50%(5/40),which was lower than that in the control group(χ^(2)=4.58,P=0.032).The occurrence rates of severe adverse renal events within 30 days in the observation group and the control group were 57.50%(23/40)and 60.00%(24/40),respectively,with no statistically significant difference(χ^(2)=0.05,P=0.820).Conclusions The early application of albumin and balanced crystalloid solution can shorten the hospital stay after fluid resuscitation in patients with severe sepsis,maintain the fluid balance,improve the hemo

关 键 词：脓毒症 白蛋白 平衡晶体液 液体复苏 预后 

分 类 号：R459.7[医药卫生—急诊医学]