胃癌术后患者是否需要常规补充白蛋白?

Should albumin be a conventional medication after gastrectomy?

1例61岁男性胃癌患者术后常规补充白蛋白后导致低白蛋白血症、腹腔引流液增加及胸腔积液。临床药师与医师共同围绕术后患者补充白蛋白的问题进行文献复习和讨论,最终达成胃癌术后患者白蛋白应用共识:(1)不推荐胃癌术后常规补充白蛋白;(2)白蛋白不是有效的氮源,且成本过高,不宜作为术后营养或蛋白质补充的来源;(3)对于术后出现低蛋白血症(血清白蛋白<30g/L)的患者,在术后应激期(第4天)后开始补充白蛋白,血清白蛋白>30g/L时停止使用;(4)对术后存在腹腔和/或胸腔积液的患者应首先明确积液性质,确定为漏出液时方可补充白蛋白。

A 61-year-old male patient with gastric cancer received routine albumin supplementation after surgery, which resulted in hypoalbuminemia, increased abdominal drainage fluid and pleural effusion. Clinical pharmacists and surgeons did literature reviews and discussions, and finally reached consensuses on albumin administration of patients after gastric cancer surgery. The consensuses were as follows:(1) it is not recommended to conduct albumin supplementation routinely after gastric cancer surgery;(2) albumin is not an effective nitrogen source and it cost too much to be used as a source of postoperative nutrition or protein;(3) for patients with postoperative hypoproteinemia (<30 g/L), albumin supplementation should be used after the surgical stress response period (day 4 after the surgery) and discontinued when the serum albumin is >30 g/L;(4) for patients with peritoneal and/or pleural effusion after surgery, the nature of the effusion should be defined firstly, and albumin can be supplemented only when the transudate is determined.