Analiza uporabe človeškega albumina na internem oddelku Splošne bolnišnice Jesenice

Zupan, Anja (author), Kerec - Kos, Mojca (mentor), Babič, Mateja (comentor)

Človeški albumin (ČA) se uporablja pri različnih bolezenskih stanjih, pri čemer odmerjanje ni vedno jasno, pri nekaterih indikacijah pa se preiskuje tudi možnost njegove zamenjave s kristaloidi oz. sinteznimi koloidi. Namen magistrske naloge je bil določiti število bolnikov, ki so bili zaradi različnih indikacij na internem oddelku Splošne bolnišnice Jesenice v obdobju od 1. 1. 2017 do 28. 2. 2018 zdravljeni s ČA in oceniti ustreznost njegove uporabe glede na navodila Splošne bolnišnice Jesenice, druge klinične smernice ter objavljene klinične raziskave. Podatke o aplikaciji ČA smo pridobili s pomočjo obrazcev »Uporaba albumina« ter iz ostale medicinske dokumentacije bolnikov. V raziskavo smo vključili 66 bolnikov s povprečno starostjo 71,1 let. Mediana števila aplikacij ČA pri posameznem bolniku je bila 7 (najmanj 1, največ 27). Najpogostejša indikacija, za katero je bil predpisan ČA, je bila razbremenilna paracenteza (121 aplikacij; 57,1 %) pri 28 bolnikih. Ustrezen odmerek je bil apliciran v 7,4 %, prenizek odmerek pa v 80,2 %. V dodatnih 12,4 % primerov so bolniki prejeli ČA, čeprav je bil volumen izčrpanega ascitesa pod 5 L, in v takšnih primerih se glede na navodila bolnišnice ČA ne dodaja. Nekatere raziskave/priporočila sicer takšno aplikacijo zagovarjajo. Indikacija za 26 aplikacij ČA pri 9 bolnikih je bila hepatorenalni sindrom. Ovrednotili smo 2 primera, pri katerih smo pridobili vse potrebne informacije za analizo in ugotovili, da zdravljenje s ČA ni bilo v celoti skladno z navodili Splošne bolnišnice Jesenice. Pri 32 bolnikih z 52 aplikacijami (24,5 %) so bile indikacije za ČA opredeljene kot individualna presoja zdravnika. Pod individualno presojo so združene različne indikacije, za katere se smernice za odmerjanje ČA razlikujejo. Najpogostejši indikaciji sta bili povečanje diureze ter sepsa, ki sta bili zdravljeni s ČA v skladu z dostopno literaturo. Pri nobeni od indikacij za uporabo ČA, ki so bile navedene pri vključenih bolnikih, ni zadostnih dokazov, da se ČA lahko zamenja za drug kristaloid ali sintetični koloid. Izjema sta sepsa in akutni pankreatitis, kjer je zdravilo prvega izbora še vedno kristaloid. V prihodnje bi bilo smiselno spodbuditi redno tehtanje bolnikov v primerih, ko se ČA odmerja na telesno maso ter dosledno izpolnjevanje obrazcev »Uporaba albumina« za vsako posamezno aplikacijo ČA. Z obrazcem je bilo namreč zabeleženih le 62,3 % vseh enot ČA, ki so bile izdane v lekarni Splošne bolnišnice Jesenice.

• Language: Slovenian
• Keywords: človeški albumin, Splošna bolnišnica Jesenice, razbremenilna paracenteza, hepatorenalni sindrom
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2019
• PID: 20.500.12556/RUL-106419
• Publication date in RUL: 22.02.2019

Secondary language

• Language: English
• Title: Analysis of human albumin use at the Internal medicine ward of the Jesenice General Hospital

Abstract

Human albumin is used in various diseases, but its dosing is not always clear. Moreover, at certain indications substitution with crystalloids and synthetic colloids is being investigated. The aim of our work was to determine the number of patients treated with human albumin due to different indications at the Internal medicine ward of the Jesenice General Hospital from 1. 1. 2017 to 28. 2. 2018, and to determine the adequacy of human albumin application according to the hospital instructions, other clinical guidelines and published clinical studies. The data about the albumin application was obtained from the document entitled »Use of albumin« and the rest of patients’ medical documentation. 66 patients were included in the study with the average age 71.1 years. The median number of human albumin applications was 7 (minimum 1, maximum 27). The most common indication for which albumin was prescribed was paracentesis in 28 patients (121 applications; 57.1 %). The dose was adequate in 7.4 % cases and too low in 80.2 %. Additionally, in 12.4 % of cases the patients received the medicine, although the volume of the drained ascites was less than 5 L. According to the hospital instructions in these cases human albumin should not be applied. However, some clinical studies and guidelines approve such application. Hepatorenal syndrome was present in 9 patients with altogether 26 applications of human albumin. In two examined cases, that included all the information necessary for the analysis, we found that treatment with albumin did not completely follow the recommendations. In 32 patients with 52 applications (24.5 %) the indications for albumin treatment were determined as individual judgment of the doctor. In these cases dosing differs according to individual indication. The most common indications were the increase of diuresis and sepsis and they were both treated with human albumin in accordance with the available literature. For none of indications present in our group of patients there is not enough evidence that human albumin can be substituted by another crystalloid or synthetic colloid. Exceptions are sepsis and acute pancreatitis, where crystalloid is still the first-line treatment. In the future we would encourage to regularly weigh patients, especially in cases, where human albumin dose depends on body weight, and to fill out the documents entitled »Use of albumin« more consistently for each individual human albumin application. In our study only 62.3 % of all human albumin applied to the patients was appropriately documented.

• Keywords: human albumin, the Jesenice General Hospital, paracentesis, hepatorenal syndrome