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科兰损伤小组的报告说明没有随机试验证据支持使用白蛋白。然而支持在大手术大量失血情况下应用白蛋白的争论却很强烈。用红细胞及类晶体或人工胶体替代会稀释包括白蛋白在内的血清成份。初始的损失从组织库来弥补。然而当超过某一阀值时,血清白蛋白浓度降低,组织库变空。研究表明,一旦出现这种状态,输注白蛋白亦不能再阻止变为多数器官衰竭和病人死亡。 荷兰癌症研究所的经验提示在大手术中适时地用白蛋白作补充能够防止这种情况。自1996年起,作者用侵袭性细胞减少和高温腹膜内丝裂霉素治疗了21例腹膜假粘液瘤。在这些长时间(平均12小时)手术中大量失血及失血浆(平均20升)。整个手术过程中作者输用20％白蛋白,使患者血清白蛋白浓度维持在35g/l以上。外周或肺水肿很少见到。手术后所有病人自
The report of the Corning Injury Panel states that no randomized trial supports the use of albumin. However, the debate that supports the use of albumin in the event of major blood loss in major surgery is intense. Replacement with red blood cells and similar crystals or artificial colloids will dilute the serum components, including albumin. The initial loss from the tissue bank to make up. However, when a threshold is exceeded, the serum albumin concentration decreases and the tissue bank becomes empty. Studies show that once this condition occurs, albumin infusion can no longer prevent the most organ failure and patient death. The experience of the Dutch Cancer Institute suggests that timely supplementation of albumin in major surgery can prevent this. Since 1996, the authors treated 21 patients with peritoneal pseudomyxoma with reduced invasiveness and high temperature intraperitoneal mitomycin. During these long hours (average of 12 hours) surgery, there was a lot of blood loss and plasma loss (an average of 20 liters). The authors lost 20% albumin during the entire procedure, maintaining the patient’s serum albumin concentration above 35 g / l. Peripheral or pulmonary edema rarely seen. All patients after surgery