中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (07): 597-599.

• 论著 • 上一篇    下一篇

尿微量白蛋白对腹部大手术后病人预后预测价值研究

朱国超，李    荣，全卓勇，张应天   

  1. 江汉大学附属医院，湖北武汉430015
  • 出版日期:2010-07-01 发布日期:2010-06-17

  • Online:2010-07-01 Published:2010-06-17

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摘要：

目的    研究尿微量白蛋白与腹部大手术后病人预后的关系。方法    选择江汉大学附属医院2007年9月至2009年4月期间收治的118例腹部大手术病人，连续动态监测腹部大手术后48h内尿微量白蛋白/尿肌酐值（ACR）、入ICU时动脉血乳酸值（LAC）、PaO2/FiO2值和术后各种并发症的发生。ROC曲线比较ACR、POSSUM评分、LAC、PaO2/FiO2值预测术后并发症的价值。结果    术后13例（11%）出现并发症，并发症组入ICU后0、6、12、18、24和48h ACR值显著高于无并发症组（P≤0.001），相关分析显示入ICU后24h 、48h ACR与POSSUM评分（r=0.374, P＜0.001，r=0.390, P＜0.001）、LAC（r=0.381, P<0.001，r=0.296, P=0.001）呈正相关，与PaO2/FiO2值（r=-0.27, P=0.003，r=－0.251, P=0.006)存在负相关。ROC曲线显示24h ACR ROC曲线为0.857，48h ACR ROC曲线为0.946，而POSSUM评分ROC曲线为0.89，24h ACR值取临界值5.0g/mol时，其预测敏感度86.7%, 特异度33.3％，死亡的阳性预测值16.9%，阴性预测值94.1%。结论    动态监测尿微量白蛋白可作为预测术后并发症的可靠指标。

关键词: 尿微量白蛋白, 腹部大手术

Abstract:

Microalbuminuria as predictor of outcome after major abdominal surgery        ZHU Guo-chao, LI Rong，QUAN Zhuo-yong，et al.Department of Surgery , the Affiliated Hospital of Jianghan University, Wuhan 430015,China
Corresponding author : LI Rong，E-mail: rongman@163.com
Abstract    Objective    To evaluate microalbuminuria as predictor of outcome after major abdominal surgery.  Methods  Microalbuminuria (ACR) was measured in 48 hours post-operation and arterial lactate, PaO2/FiO2 ratio at ICU admission. Receiver-operator curves (ROC) were constructed to compare ACR, physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) score, LAC and PaO2/FiO2 ratio to predict outcome. Results    A total of 13 postoperative complications were recorded in 118 patients (11%). ACR at ICU admission and 6, 12, 18, 24 and 48 hours at ICU was significantly higher in patients with postoperative complications than in those without complications （P≤0.001）. ACR at 24 and 48 hours were positively correlated with POSSUM （r=0.374, P＜0.001，r=0.390, P＜0.001）、LAC（r=0.381, P<0.001，r=0.296, P=0.001）and LAC （r=0.381, P<0.001，r=0.296, P=0.001）and inversely correlated with mean PaO2/FiO2（r=-0.27, P=0.003，r=-0.251, P=0.006). The area of ROC of ACR at ICU 24, 48 hour and POSSUM to morbidity was statistically higher than 0.5 (0.857 vs 0.946 vs 0.89). Using a cutoff for ACR at ICU 24 hour of 5.0g/mol. The sensitivity for complication was 86.7%, with specificity of 33.3% and the positive predictive value of death was 16.9%, with negative predictive value of 94.1%. Conclusion    ACR is a valuable predictor of in-hospital outcome after major abdominal surgery.

Key words: microalbuminuria, major abdominal surgery