晶体液联合血浆进行液体复苏对低蛋白血症脓毒症患者预后的影响  

Effect of fluid resuscitation with crystalloid combined with plasma on the prognosis of septic patients with hypoalbuminemia

作　　者：许伟伟 李晶菁[3] Xu Weiwei;Li Jingjing(Nantong University,Nantong 226001,Jiangsu,China;Department of Critical Care Medicine,Dongtai People's Hospital,Dongtai 224200,Jiangsu,China;Department of General Medicine,the Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu,China)

机构地区：[1]南通大学,江苏南通226001 [2]东台市人民医院重症医学科,江苏东台224200 [3]南通大学附属医院全科医学科,江苏南通226001

出　　处：《中华危重病急救医学》2024年第8期808-812,共5页Chinese Critical Care Medicine

基　　金：江苏省南通市卫生健康委员会指令性科研课题面上项目(MS2023012)。

摘　　要：目的评估单独使用晶体液和晶体液联合血浆输注两种液体复苏方案对低蛋白血症脓毒症患者预后的疗效差异。方法采用回顾性研究,选取2017年1月至2022年12月江苏省东台市人民医院重症医学科收治的低蛋白血症脓毒症患者作为研究对象,根据入院时液体复苏方案分为单一组(单纯使用晶体液)和联合组(晶体液联合血浆)。收集患者一般资料、以及复苏前(入院第1天)及复苏第3天的凝血功能指标。主要研究终点是28 d病死率。将单一组和联合组分别根据复苏时的初始白蛋白水平(<25 g/L、25~30 g/L、>30 g/L)进行分层,比较不同白蛋白水平患者28 d病死率的差异。绘制患者28 d Kaplan-Meier生存曲线。结果共纳入164例低蛋白血症脓毒症患者,其中单一组60例,联合组104例。①两组患者年龄、性别、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、以及复苏前血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体、抗凝血酶Ⅲ(AT-Ⅲ)、国际标准化比值(INR)、纤维蛋白降解产物(FDP)、血清乳酸(Lac)、白蛋白水平差异均无统计学意义,具有可比性。②联合组第3天PT、AT-Ⅲ水平均较复苏前明显改善,且联合组第3天AT-Ⅲ较单一组改善更明显〔(79.80±17.95)%比(66.67±18.69)%,P<0.01〕。单一组和联合组复苏后Lac、白蛋白水平均明显改善,但两组间改善程度比较差异无统计学意义。③单一组与联合组28 d病死率比较差异无统计学意义〔55.0%(33/60)比42.3%(44/104),P>0.05〕。白蛋白<25 g/L者的28 d病死率明显高于白蛋白25~30 g/L者和白蛋白>30 g/L者〔63.1%(41/65)比36.2%(25/69)、36.7%(11/30),均P<0.05〕。④Kaplan-Meier生存曲线分析显示,单一组与联合组28 d累积生存率差异无统计学意义(Log-Rank检验:χ^(2)=2.067,P=0.151)。单一组中位生存率时白蛋白水平为27.1 g/L〔95%可信区间(95%CI)为24.203~Objective To evaluate the difference in efficacy of two fluid resuscitation regimens,crystalloid alone versus crystalloid combined with plasma infusion,on the prognosis of septic patients with hypoalbuminemia.Methods A retrospective study was conducted.Septic patients with hypoalbuminemia admitted to the department of critical care medicine of Dongtai People's Hospital from January 2017 to December 2022 were selected as study subjects.Patients were divided into single group(crystalloid alone)and combined group(crystalloid combined with plasma)according to the fluid resuscitation regimen at the time of admission.General information,as well as coagulation indices before resuscitation(on day 1)and day 3 of resuscitation were collected.The primary study endpoint was 28-day mortality.The single and combined groups were stratified according to albumin level at resuscitation(<25 g/L,25-30 g/L,and>30 g/L)to compare the differences in 28-day mortality among patients with different albumin levels.Kaplan-Meier survival curves of patients'28-day prognosis were plotted.Results A total of 164 septic patients with hypoalbuminemia were included,including 60 patients in the single group and 104 patients in the combined group.①There were no significantly differences in age,gender,acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),as well as pre-resuscitation platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer,antithrombin-Ⅲ(AT-Ⅲ),international normalized ratio(INR),fibrin degradation product(FDP),serum lactic acid(Lac),and albumin level between the two groups,indicating comparability.②The levels of PT and AT-Ⅲin the combined group improved significantly on day 3 compared to before resuscitation,and the level of AT-Ⅲin the combined group improved more significantly on day 3 compared to the single group[(79.80±17.95)%vs.(66.67±18.69)%,P<0.01].Lac and albumin levels improved significantly after resuscitation in both the single a

关 键 词：脓毒症 液体复苏 病毒灭活血浆 晶体液 低蛋白血症 

分 类 号：R459.7[医药卫生—急诊医学]