早产儿低蛋白血症

早产儿低蛋白血症颜卫源2016-03-1612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.早产儿白蛋白水平•61pretermbabies•ReadingRF,EllisR,FleetwoodA.Plasmaalbuminandtotalproteininpretermbabiesfrombirthtoeightweeks[J].EarlyHumanDevelopment,1990,22(2):81-87.早产儿白蛋白水平•61pretermbabies•ReadingRF,EllisR,FleetwoodA.Plasmaalbuminandtotalproteininpretermbabiesfrombirthtoeightweeks[J].EarlyHumanDevelopment,1990,22(2):81-87.早产儿白蛋白水平•61pretermbabies•ReadingRF,EllisR,FleetwoodA.Plasmaalbuminandtotalproteininpretermbabiesfrombirthtoeightweeks[J].EarlyHumanDevelopment,1990,22(2):81-87.早产儿白蛋白水平•195infantsof25to42weeks•MillerPW.Serumalbuminconcentrationsandoedemainthenewborn.[J].ArchivesofDiseaseinChildhood,1986,61(7):657-60.早产儿白蛋白水平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.为早产儿输注白蛋白能否获益•JardineLA,Jenkins-ManningS,DaviesMW.Albumininfusionforlowserumalbumininpretermnewborninfants[J].CochraneDatabaseofSystematicReviews,2004,3(3).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。入选文献的白蛋白水平•haveaplasmaalbuminlevelbelow30g/Lat48to72hoursoflife。•Studysubjectswerenewborninfantswhowereventilatordependantatlessthansevendaysofageandhadaserumalbuminlevelof≤30g/L•lowbirthweightnewborninfantsatriskforrespiratorydistresswhowereacidaemicwithalowtotalserumproteinlevel(whethertheywerehypoalbuminaemicornotisunknown).仅有3篇文献入选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),plasmaproteinmeasurementsondayoneoflifeinverypreterminfants•severeadverseoutcome：Thiswasdefinedasdeathorsevere(grade3or4)intraventricularhemorrhageorcysticperiventricularleukomalaciaoccurringbeforeinfants’dischargefromhospital•Conclusions:Earlyhypoproteinemiahasprognosticvalueforsevereadverseoutcomeinverypreterm,sickinfants.TotalplasmaproteinhasapredictiveperformancecomparablewithCRIBandSNAPPE-IIandgreaterthanothervalidatedseverityscores.12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.谢谢颜卫源2016-03-16