不同白蛋白输注阈值在儿童毛细血管渗漏综合征中的影响

Clinical study of different albumin infusion threshold in capillary leakage syndrome in children

目的毛细血管渗漏综合征(capillary leak syndrome,CLS)的患儿输注白蛋白时不同血清白蛋白阈值的有效性及安全性尚不清楚。本研究分析不同血清白蛋白输注阈值在儿童CLS中的影响。方法收集2018年1月至2020年12月在广东医科大学附属东莞儿童医院PICU收治的75例合并毛细血管渗漏综合征并确定接受白蛋白输注的机械通气患儿临床信息。将输注白蛋白浓度为30g/L(低阈值,n=42)的患儿与输注白蛋白浓度为40g/L(高阈值,n=33)的患儿进行分组,分别比较其机械通气时间、CRRT使用率、PICU住院时间及28d死亡率。结果与低阈值组比较,高阈值组机械通气时间减少,CRRT使用率降低,PICU住院时间缩短,差异有统计学意义。两组的28d死亡率差异没有统计学意义。结论与血清白蛋白浓度为40g/L以下相比,在血清白蛋白浓度为30g/L以下时输注白蛋白与发生CLS患儿的28d死亡率增加无关。然而,在血清白蛋白浓度为40g/L以下时输注白蛋白,能有效减少机械通气时间、CRRT使用率及PICU住院时间。

Objective The efficacy and safety of different plasma albumin thresholds for albumin infusion in children with capillary leakage syndrome(capillary leak syndrome,CLS)are unknown.Methods Clinical data of 75 children admitted to PICU from January 2018 to December 2020 at Dongguan Children’s Hospital affiliated to Guangdong Medical University with capillary leakage syndrome and confirmed albumin infusion was collected.Children with an albumin concentration of30 g/L(low threshold,n=42)were grouped with40 g/L(high threshold,n=33)and compared with mechanical ventilation,CRRT utilization,PICU hospitalization and28 day mortality,respectively.Results Compared with the low threshold group,mechanical ventilation time was decreased while the CRRT utilization rate and PICU hospitalization time were decreased.There was no significant difference in28 day mortality between the two groups.Conclusions The analysis showed that albumin infusion at plasma concentrations below30 g/L was independent of increased 28 day mortality in children with CLS,compared to plasma albumin concentrations below40 g/L.However,infusion of albumin at plasma albumin concentrations below40 g/L can effectively reduce mechanical ventilation time,CRRT utilization,and PICU hospitalization time.