早产儿低蛋白血症ppt课件

早产儿低蛋白血症 1 1 2 为早产儿输注白蛋白能否获益 3 扩展 生后第1天总蛋白水平与早产儿结局相关 目录 早产儿白蛋白水平 2 早产儿白蛋白水平 ReadingRF EllisR FleetwoodA Plasmaalbuminandtotalproteininpretermbabiesfrombirthtoeightweeks J EarlyHumanDevelopment 1990 22 2 81 87 MillerPW Serumalbuminconcentrationsandoedemainthenewborn J ArchivesofDiseaseinChildhood 1986 61 7 657 60 3 早产儿白蛋白水平 61pretermbabiesReadingRF EllisR FleetwoodA Plasmaalbuminandtotalproteininpretermbabiesfrombirthtoeightweeks J EarlyHumanDevelopment 1990 22 2 81 87 4 早产儿白蛋白水平 61pretermbabiesReadingRF EllisR FleetwoodA Plasmaalbuminandtotalproteininpretermbabiesfrombirthtoeightweeks J EarlyHumanDevelopment 1990 22 2 81 87 5 早产儿白蛋白水平 61pretermbabiesReadingRF EllisR FleetwoodA Plasmaalbuminandtotalproteininpretermbabiesfrombirthtoeightweeks J EarlyHumanDevelopment 1990 22 2 81 87 6 早产儿白蛋白水平 195infantsof25to42weeksMillerPW Serumalbuminconcentrationsandoedemainthenewborn J ArchivesofDiseaseinChildhood 1986 61 7 657 60 7 早产儿白蛋白水平 8 为早产儿输注白蛋白能否获益 JardineLA Jenkins ManningS DaviesMW Albumininfusionforlowserumalbumininpretermnewborninfants J CochraneDatabaseofSystematicReviews 2004 3 3 9 为早产儿输注白蛋白能否获益 结论尚缺乏有力的证据去证明为存在低蛋白血症的早产儿输注白蛋白能够改善死亡率 但同样没有足够的证据指出白蛋白有显著的副作用 10 入选文献的白蛋白水平 haveaplasmaalbuminlevelbelow30g Lat48to72hoursoflife Studysubjectswerenewborninfantswhowereventilatordependantatlessthansevendaysofageandhadaserumalbuminlevelof 30g Llowbirthweightnewborninfantsatriskforrespiratorydistresswhowereacidaemicwithalowtotalserumproteinlevel whethertheywerehypoalbuminaemicornotisunknown 仅有3篇文献入选 11 为早产儿输注白蛋白能否获益 早产儿早期 小于30g L即输注白蛋白不一定能获益 12 总蛋白水平与早产儿严重不良结局相关 SilviaI FrancescoB CatherineQ etal Totalplasmaproteininverypretermbabies prognosticvalueandcomparisonwithillnessseverityscores J PlosOne 2013 8 4 e62210 761infantswerestudied totalproteinleveloflessthan40g L plasmaproteinmeasurementsondayoneoflifeinverypreterminfantssevereadverseoutcome Thiswasdefinedasdeathorsevere grade3or4 intraventricularhemorrhageorcysticperiventricularleukomalaciaoccurringbeforeinfants dischargefromhospital 13 Conclusions Earlyhypoproteinemiahasprognosticvalueforsevereadverseoutcomeinverypreterm sickinfants TotalplasmaproteinhasapredictiveperformancecomparablewithCRIBandSNAPPE IIandgreaterthanothervalidatedseverityscores 14 1 2 早产儿早期 小于30g L即输注白蛋白不一定能获益 3 早产儿早期出现总蛋白水平降低预示出现严重不良结局的可能性大 总结 早产儿白蛋白水平应当大于20g L 35周左右达到25g L 39周左右达到30g L 15