某院住院患者人血白蛋白临床应用评价与分析

Evaluation and analysis of clinical application of human serum albumin in inpatients in a hospital

目的:为临床合理应用人血白蛋白提供参考。方法:采用回顾性分析方法,抽取某院2017-2020年应用人血白蛋白的住院患者病历,对科室用药情况分布、患者个人用量分布、用药前血清白蛋白水平进行统计分析,并以美国白蛋白应用指南(2010年版)、2018年《临床药物治疗杂志》人血白蛋白合理使用专栏和《人血白蛋白用于肝硬化治疗的快速建议指南》解读(2018年版)为标准进行评价。结果:该院339例应用人血白蛋白的患者主要分布在消化内科(24.5%)、重症医学科(17.4%)、肿瘤科(16.2%)及呼吸及危重症医学科(10.3%);用药前血清白蛋白水平以20~<25g﹒L;(50.7%)为主;用药理由主要集中在以下方面:低蛋白血症(36.9%)、肝硬化腹水(11.2%)、癌症相关性水肿(9.1%)、营养支持(8.0%)和脓毒血症(7.1%);仅92例(27.1%)白蛋白用药理由与相关指南或循证医学证据相符合,最主要的不适宜用药理由为纠正低白蛋白血症。结论:该院白蛋白临床应用适应症与相关循证医学证据符合率偏低,存在不合理用药情况,需加强管理,规范人血白蛋白的合理使用。

Objective: To provide references for clinical rational application of human serum albumin. Method: Retrospective analysis was used to extract the medical records of inpatients who used human serum albumin from 2017 to 2020 in a hospital. Statistical analysis was made on the distribution of drug use in departments, individual dosage distribution of patients and serum albumin level before medication. The evaluation was based on the American Guidelines for the Application of albumin(2010 edition), the rational use column of human albumin in the Journal of Clinical Drug Therapy(2018 edition) and the interpretation of the Rapid Recommendation Guidelines for the Treatment of Liver Cirrhosis(2018 edition). Result:339 patients who used human serum albumin were mainly distributed in the department of gastroenterology(24.5%), ICU(17.4%), oncology(16.2%) and respiratory and critical care medicine(10.3%). The concentration of serum albumin before medication was mainly 20~<25 g﹒L-1(50.7%). The main reasons were hypoalbuminemia(36.9%), cirrhotic ascites(11.2%), cancer-related edema(9.1%), nutritional support(8.0%) and sepsis(7.1%). Only 92 cases(27.1%) of albumin application were consistent with the relevant guidelines or evidence-based medical evidence. The most prevalent irrational reason was for correcting hypoalbuminemia. Conclusion: The clinical application of albumin has a low coincidence rate with evidence-based medicine in the hospital and exists irrational drug use, so it is necessary to strengthen management and standardize rational use of human serum albumin.