美国医院联合会人血白蛋白、非蛋白胶体及晶体溶液使用指南(中英对照) Adapted from UHC Guidelines for the Use of Albumin, Nonprotein Colloid, and Crystalloid Solutions, May 2000.
美国医院联合会人血白蛋白、非蛋白胶体及晶体溶液使用指南(2000年 5月)
网络压力测试
Hemorrhagic Shock
?Crystalloids should be considered the initial resuscitation fluid of choice.
?Nonprotein colloids may be considered over crystalloids when crystalloids (4 L) have failed to produce a response within 2 hours for adult patients.
?When nonprotein colloids are contraindicated*, albumin 5 percent may be used.
?Patients who experience shock symptoms while under-going hemodialysis are included in this guideline.
出血性休克
?晶体溶液可以作为首选药物用于扩张血容量。
?成人患者输入 4L 晶体液后 2小时无效,可考虑非蛋白胶体液。 ?当对非蛋白胶体液有禁忌,可以考虑使用 5%白蛋白。
?在进行血液透析过程中出现休克表现,也符合如上处理原则。
Nonhemorrhagic (Maldistributive) Shock
?Crystalloids should be considered first-line therapy for nonhemorrhagic shock. Clinical trials have not shown colloids to be more effective in treating sepsis.
?In the presence of capillary leak with pulmonary and/or severe peripheral edema, the
administration of up to 4 L of crystalloids in adults before using colloids is appropriate. ?If nonprotein colloids are contraindicated*, albumin may be given.
?Nonprotein colloids and albumin should be used with caution in patients with systemic sepsis.
非出血性(分布异常性)休克
?对于非出血性休克,晶体溶液可作为一线药物。临床研究尚未证实胶体溶液用 于败血症更有效。
dvd机芯
?发生毛细血管渗漏伴肺水肿或严重外周水肿时,使用胶体溶液之前,成人患者应先 给予 4L 晶体溶液。
?如果非蛋白胶体溶液存在禁忌,给予白蛋白。
?对于败血症的患者,应慎用非蛋白胶体和白蛋白。
Thermal Injury
?Fluid resuscitation should be initiated with crystalloid solutions.
?If crystalloid resuscitation exceeds 4 L in adults 18 to 26 hours postburn, and burns cover more than 30 percent of the patient’s body surface area, nonprotein colloids may be added. ?If nonprotein colloids are contraindicated*, albumin may be used
烧伤
?晶体溶液可作最初扩张血容量之用。
?成人患者烧伤后 18-26小时内使用的晶体溶液已超过 4L , 烧伤面积大于体表面积的 30%,加用非胶体溶液。
?如果非蛋白胶体溶液存在禁忌,给予白蛋白。
亚克力水晶字制作 Cerebral Perfusion Pressure (CPP)
太阳能沼气池 ?Crystalloid administration should be the first choice of treatment in maintaining CPP for treatment of vasospasm associated with subarachnoid hemorrhage, cerebral ischemia, or head trauma. Patients with elevated hematocrits should first receive crystalloids to expand
intravascular volume. Mannitol should be used to reduce intracranial hypertension.
?If cerebral edema is a concern, albumin should be used in concentrated form (25 perce
nt) as a colloid to maintain CPP.医用热熔胶
?If the hematocrit is less than 30, use packed red blood cells to increase the intravascular volume and maintain CPP. If volume therapy alone is ineffective, vasopressors may be needed
脑灌注压 (CPP)
?对于蛛网膜下腔出血、缺血性中风和头部创伤引起的血管痉挛,应首选晶体溶液维 持 CPP 。 红细胞比容偏 高的患者应首先用晶体溶液来扩张血容量。可应用甘露醇降 低颅内压。
?如果存在脑水肿的危险,应使用高浓度白蛋白(25%)胶体液维持 CPP 。
?如果红细胞比容低于 30, 使用浓集红细胞扩张血容量和维持 CPP 。 如扩容无效, 应使用血管收缩药。
Nutritional Intervention
取样装置 ?Albumin should not be used as a supplemental source of protein calories in patients requiring nutritional intervention.
?Patients who cannot tolerate enteral feeding may benefit from the administration of
nonprotein colloids if all of the following conditions are met:
1. Serum albumin less than g/dL
2. Functioning gastrointestinal tract
3. Failed short-chain peptide formulas
营养干预
?对于需要营养干预的患者,白蛋白不能作为蛋白质的补充来源。
?对于不能耐受肠道喂食的患者,如符合下列各条件,使用非蛋白胶体则可能获益:
1. 血清白蛋白浓度低于 dl
2. 严重腹泻(>2L/d)
3. 使用短肽无效
Cardiac Surgery
?Crystalloids should be the fluid of choice as the priming solution for cardiopulmonary bypass pumps.
?The use of nonprotein colloids in addition to crystalloids may be preferable in cases in which it is extremely important to avoid pulmonary shunting.
?For postoperative volume expansion, crystalloids should be considered first-line therapy, followed by nonprotein colloids, and finally albumin.
心脏手术
?晶体溶液应作为体外循环泵的首选溶液。
?亟须避免发生肺间质积液时,联合使用非蛋白胶体和晶体溶液效果更好。
?术后扩充血容量,首选晶体溶液,其次为非蛋白胶体,最后是白蛋白。
Hyperbilirubinemia of the Newborn
?Albumin should not be administered in conjunction with phototherapy.
?Albumin may be a useful adjuvant to exchange transfusions when administered concurrently with blood transfusion but it should not be used before transfusion.
?Crystalloids and nonprotein colloids do not have bilirubin binding properties and should not be considered as alternatives to albumin.
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