基于国内外指南分析某院外科住院患者人血清白蛋白临床使用情况

Clinical Use of Human Serum Albumin for Surgical Inpatients in a Hospital Based on Domestic and Foreign Guidelines

目的为临床合理使用人血清白蛋白(HSA)提供参考。方法采用回顾性分析法,选取医院2020年1月至12月使用HSA的住院患者1 257例,统计基本信息、科室、出入院诊断、用法用量及使用前血清白蛋白指标等信息,以美国大学医院联合会(UHC)《人血白蛋白、非蛋白胶体及晶体溶液使用指南》(简称《UHC指南》)和《北京市医疗机构处方专项点评指南(试行)》(简称《国内指南》)为依据对HSA的临床使用情况进行合理性分析与评价。结果共使用HSA 11 122支,HAS使用科室主要分布在肝胆胰外科(47.09%)和重症医学科(31.51%)。1 257例患者中,HSA主要适应证有低蛋白血症(44.23%)和大手术期间白蛋白补充(15.04%);符合《国内指南》适应证的占63.64%,符合《UHC指南》适应证的占21.56%;使用HSA前血清白蛋白浓度低于25 g/L的占11.22%,在25~40 g/L范围内的占86.15%。结论该院HSA的临床使用存在不合理现象和使用误区,医院应加强管控不合理应用的原因,促进其合理使用,提高用药的有效性和安全性。

Objective To provide a reference for clinical rational use of human serum albumin(HSA).Methods Retrospective analysis method was conducted,1 257 surgical inpatients treated with HSA in the hospital from January to December 2020 were selected to analyze the basic information,departments,admission and admission diagnosis,usage and dosage and serum albumin indexes before use.The rationality of the clinical use of HSA was analyzed and evaluated based on the University Hospital Consortium(UHC) Guidelines for the Use of Albumin,Nonprotein Colloid,and Crystalloid Solutions(hereinafter referred to as the UHC Guidelines) and the Guidelines for Special Comments on Prescriptions of Medical Institutions in Beijing(trial,hereinafter referred to as the Domestic Guidelines).Results A total of 11 122 HSA were used,and the main departments using HAS were Hepatobiliary and Pancreatic Surgery(47.09%) and Critical Medicine(31.51%).Among the 1 257 patients,the main indications of HSA were hypoproteinemia(44.23%) and albumin supplementation during major surgery(15.04%).The indications in accordance with the Domestic Guidelines accounted for 63.64%,and the indications in accordance with the UHC Guidelines accounted for 21.56%.The concentration of serum albumin before HSA was lower than 25 g/L accounted for 11.22%,and that in the range of 25-40 g/L accounted for 86.15%.Conclusion There are unreasonable phenomena and mistake in the clinical use of HSA in the hospital.The hospital should strengthen the control of the causes of unreasonable application,promote its clinical rational use,and improve the effectiveness and safety of the medication.