白蛋白联合醋酸钠林格注射液作为置换液在儿童血浆置换治疗中的安全性观察
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南京医科大学附属儿童医院

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国家自然科学基金面上项目(82170733)


Safety of Albumin Combined with Acetate Ringer"s Solution as Replacement Fluid in Therapeutic Plasma Exchange of PediatricQIAN Yali, FAN Mingxing, MIAO Hongjun, GE Xuhua*
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1.Children'2.'3.s Hospital of Nanjing Medical University

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National Nature Science Foundation of China(82170733)

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    摘要:

    摘要 目的:观察白蛋白联合醋酸钠林格注射液作为置换液在儿童患者中行血浆置换治疗(TPE)的安全性。方法:纳入南京医科大学附属儿童医院儿科重症监护病房(PICU),2019年4月至2023年3月期间因疾病本身需要进行TPE的患者共20例,按随机数字表法分为观察组和对照组。观察组患者置换液使用20%人血白蛋白联合醋酸钠林格注射液按照1:5的比例配置,对照组患者的置换液使用新鲜冰冻血浆。对两组患者治疗过程中血流动力学指标及不良事件的发生,治疗结束后1周凝血指标、生化指标及基础疾病的反应进行组间比较,对两组患者治疗前后凝血指标、生化指标进行组内比较。结果:治疗过程中两组患者的平均动脉压及心率稳定,差异无统计学意义(P>0.05)。观察组的总蛋白(TP)、球蛋白(GLB)、纤维蛋白原(Fbg)、血磷(P)、血钙(Ca2+)较治疗前下降,差异有统计学意义(P<0.05)。对照组的白蛋白(ALB)、国际标准化比值(INR)、凝血酶原时间(PT)、P、Ca2+、血镁(Mg2+)较治疗前下降,差异有统计学意义(P<0.05);两组治疗后变态反应及低钙血症发生率差异无统计学意义(P>0.05)。两组治疗结束后1周的凝血指标、生化指标及基础疾病的反应无统计学意义(P>0.05)。结论:在儿科患者中,应用20%白蛋白联合醋酸钠林格注射液(1:5)作为置换液行TPE是安全的,可有效节约血液资源,但治疗过程中需监测患者凝血及生化相关指标,及时补充新鲜冰冻血浆等血制品纠正凝血功能。

    Abstract:

    【Abstract】Objective: To investigate the safety of albumin combined with acetate Ringer's solution in therapeutic plasma exchange(TPE) of pediatrics. Methods: A total of 20 patients with diseases requiring TPE from April 2017 to March 2023 in the intensive care unit of Children’s Hospital of Nanjing Medical University were included, and were randomly divided into observation group and control group. The observation group chose 20% albumin combined with acetate Ringer's solution in the ratio of 1:5 as the replacement fluid, and the control group chose fresh frozen plasma as the replacement fluid for TPE. The hemodynamic indexes and the occurrence of complications during treatment and the coagulation indexes、biochemical indexes and the response of the underlying disease 1 week after the end of treatment between the 2 groups of patients were compared. The coagulation indexes and biochemical indexes were compared within groups before and after TPE. Results: Mean arterial pressure and heart rate were stable in both groups during treatment and the difference was not statistically significant (P>0.05); Total protein (TP), globulin (GLB), fibrinogen (Fbg), serum phosphorus (P), and serum calcium (Ca2+) decreased in the observation group compared with those before treatment, and the difference was statistically significant (P < 0.05). Albumin (ALB), international normalized ratio (INR), prothrombin time (PT), P, Ca2+, and serum magnesium (Mg2+) decreased in the control group compared with those before treatment. The incidence of allergic metaplasia and hypocalcemia between the two groups after treatment were not statistically significant (P>0.05). The coagulation indexes、biochemical indexes and the response of the underlying disease 1 week after the end of treatment between groups were not statistically significant (P>0.05). Conclusion: It is safe to apply 20% albumin combined with acetate Ringer's solution (1:5) as replacement fluid in TPE of pediatric and can effectively save blood resources, but the coagulation and biochemical indexes need to be monitored during the treatment, and blood products such as fresh frozen plasma should be supplemented promptly to correct coagulation function.

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  • 收稿日期:2023-05-29
  • 最后修改日期:2023-07-04
  • 录用日期:2023-10-25
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