基于循证医学建立我院人血白蛋白临床使用评价的标准

Establishment of Evaluation Standards for Clinical Use of Human Serum Albumin in Our Hospital Based on Evidence-based Medicine

目的:建立我院人血白蛋白(HSA)临床使用评价标准,为其专项点评和临床合理使用提供依据。方法:我院临床药师利用医院信息系统和合理用药监测系统,分析2014年全院HSA的使用情况及其主要适应证;运用循证医学的方法,以"白蛋白""albumins""albuminoid"和主要适应证(如"肝肾综合征"等)为关键词,检索Cochrane Library、Pub Med和Embase等数据库,收集相关循证医学证据,根据其证据水平和推荐级别,制订我院HSA临床使用评价标准初稿;经我院相关科室专家修订后,最终确立我院HSA临床使用评价标准。结果与结论:2014年我院共35个科室使用HSA,10种主要适应证包括低蛋白血症、肝硬化腹水、细菌性腹膜炎、肝肾综合征和外科手术等。共检索到相关文献131篇。我院HSA临床使用评价标准将10种适应证分为推荐适应证(肝肾综合征、肝硬化腹水、自发性细菌性腹膜炎和成人心脏手术)、酌情使用适应证(新生儿黄疸、感染性休克、出血性休克、烧伤、肾病综合征和胃肠外科手术)和非适应证(低蛋白血症)等3个类别,同时列出了各适应证具体的用药指征、给药方案、证据水平和推荐级别。但该标准仍需不断完善,以进一步促进HSA的合理使用。

OBJECTIVE： To establish the evaluation standards for clinical use of human serum albumin （HSA）, in order to provide basis for special comment and reasonable use of HSA in our hospital. METHODS： By using hospital information system and rational drug use monitoring system, clinical pharmacists analyze the use of HSA and main indications in 2014. In evidence-based medicine study, using ＂baidanbai albumins albuminoid＂ and main indications （such as ＂hepatorenal syndrome＂, etc.） as keywords, retrieved from Cochrane Library, PubMed, Embase and other database, related evidence-based medicine evidence were collected. According to evidence level and recommended level, preliminary evaluation standards were developed for clinical use of HSA in our hospital. After the standards was revised by the experts in relevant departments, the evaluation standards for clinical use of HSA in our hospital was finally formed. RESULTS ＆ CONCLUSIONS： HSA was used in 35 clinical departments of our hospital in 2014. 10 kinds of major indications included hypoalbuminemia, cirrhosis ascites, bacterial peritonitis, hepatorenal syndrome and surgical operation, etc. A total of 131 literatures were retrieved. According to evaluation standard for clinical use of HSA in our hospital, 10 kinds of indications involved recommended indications （hepatorenal syndrome, cirrhosis ascites, spontaneous bacterial peritonitis, cardiac surgery）, appropriate use of indications （neonatal jaundice, septic shock, hemorrhagic shock, burnt, nephrotic syndrome, gastrointestinal surgical procedures） and non-indications （hypoalbuminemia）, etc. At the same time, the indications, administration program, the level of evidence and recommended were listed for each indication. But the standard should be improved continuously so as to further promote rational use of HSA.