共识[1]指出在急性颅脑损伤所致脑出血中应用人血白蛋白(HSA)是安全的且能改善神经功能预后,因此专家建议对脑出血患者早期灌注25% HSA以改善神经功能预后。一项研究报道[2]对20例脑出血患者静注20% HSA (50 mL)或40mg呋塞米,并进行连续脑电波(EEG)监测。结果显示,HSA治疗组患者输注HSA后30min~60min内其病灶半球α波升高、δ波降低,且输注后2h仍保持显著效力(如图1所示);呋塞米治疗组患者的EEG监测记录则无明显变化。
图1 HSA治疗组患者病灶半球中央区EEG绝对频率变化平均百分比
除此之外,对于缺血性脑卒中有多个研究支持使用高剂量人血白蛋白(HSA)进行治疗。缺血性脑卒中患者对25%的HSA耐受性良好,在发病2小时内应使用高剂量HSA以改善NIHSS评分,且高剂量HSA治疗可能在缺血性中风中具有神经保护作用[3,4]。
NIHSS:美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale)
[1] Yue-Tian Yu,. Expert consensus on the use of human serum albumin in critically ill patients. Chinese Medical Journal 2021;134(14).
[2] Huang Z, Dong W, Yan Y, Xiao Q, Man Y. Effects of intravenous human albumin and furosemide on EEG recordings in patients with intracerebral hemorrhage. Clin Neurophysiol 2002;113:454–458.
[3] Renee’ H M, Yeatts S D, Hill M D, et al. Albumin in Acute Stroke (ALIAS) Trials: Analysis of the combined data from Parts 1 and 2[J]. Stroke; a journal of cerebral circulation, 2016, 47(9): 2355.
[4] Ginsberg M D, Palesch Y Y, Martin R H, et al. The albumin in acute stroke (ALIAS) multicenter clinical trial: safety analysis of part 1 and rationale and design of part 2[J]. Stroke, 2011, 42(1): 119-127.
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