Changes of the Difference between Hematocrit and Albumin in the Course of Secondary Abdominal Infection
-
摘要:
目的 通过观察HCT和ALB差值在腹腔感染患者治疗过程中的变化，为腹腔感染患者的准确治疗提供一定的指导。 方法 选取2018年1月至2018年12月昆明医科大学第一附属医院收治的各类腹腔感染手术患者共计106名，按手术时间分为术前、术后12 h、术后1 d术后2 d、术后7 d、术后14 d和术后21 d 7组（n = 106），记录患者性别、年龄；收集患者上述各时间点患者的红细胞压积、血浆白蛋白，计算HCT-ALB差值。再根据临床结局分为术后好转组和死亡组。比较每组HCT、ALB和HCT-ALB差值。 结果 与手术前相比，术后12 h、术后1 d、术后2 d和术后7 d，患者HCT和ALB下降，HCT-ALB增大（P < 0.05）；与手术前相比，术后14 d，HCT和ALB下降，（ P < 0.05），HCT-ALB差异无统计学意义（ P > 0.05）；与好转组相比，死亡组患者年龄增加（ P < 0.05），术前的HCT-ALB增大（ P < 0.05）。 结论 腹腔感染患者在手术治疗后毛细血管渗漏加重，这一病理过程可持续7 d以上，死亡患者的毛细血管渗漏更严重。 Abstract:Objective To provide the certain guidance for the accurate treatment of patients with abdominal infection by observing the changes of the difference between HCT and ALB in the treatment of patients with abdominal infection. Methods A total of 106 patients with various abdominal infection treated in the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2018 were selected and divided into 7 groups （n = 106） according to the operation time: preoperative, postoperative 12 h, postoperative 1 day, postoperative 2 days, postoperative 7 days, postoperative 14 days and postoperative 21 days. Gender and age of patients were recorded. The hematocrit and plasma albumin of patients at each time point above were collected, and the HCT-ALB difference was calculated. According to the clinical outcome, they were divided into the postoperative improvement group and the death group. The difference of HCT, ALB and HCT-ALB in each group was compared. Results Compared with those before the surgery, HCT and ALB decreased and HCT-ALB increased 12 h, 1 day, 2 days and 7 days after the surgery （P < 0.05）. Compared with those before the operation, HCT and ALB decreased 14 days after the operation （ P < 0.05）, but there was no significant difference in HCT-ALB （ P > 0.05）. Compared with the improved group, the age of patients in the death group increased （ P < 0.05）, and the preoperative HCT-ALB increased （ P < 0.05）. Conclusion Capillary leakage is aggravated in patients with celiac infection after the surgical treatment, and the pathological process lasts for more than 7 days, and the capillaries of the dead are more leaky. -
Key words:
- Hematocrit /
- Plasma albumin /
- Abdominal infection /
- Capillary leakage
-
表 1 术前、术后12 h两组HCT （%），ALB （g/L），HCT-ALB的比较（n = 92）
Table 1. Comparison of HCT，ALB and HCT-ALB between the two groups before surgery and 12h after surgery （n = 92）
组别 HCT（%） ALB（g/L） HCT-ALB 术前 39.81 ± 6.79 33.82 ± 6.72 5.99 ± 7.65 术后12 h内 36.53 ± 7.45* 23.62 ± 6.90* 12.90 ± 8.35* t 6.768 17.448 −13.812 P 0.000 0.000 0.002 与术前组相比，*P < 0.05。 
下载: 导出CSV
表 2 术前，术后1 d两组HCT （%），ALB （g/L），HCT-ALB比较（n = 45）
Table 2. Comparison of HCT，ALB and HCT-ALB between the two groups before surgery and 1 d after surgery （n = 45）
组别 HCT（%） ALB（g/L） HCT-ALB 术前 39.86 ± 7.61 33.17 ± 7.78 6.69 ± 7.08 术后1 d 33.30 ± 6.73* 22.79 ± 6.80* 10.51 ± 6.60* t 7.692 9.779 −4.011 P 0.000 0.000 0.000 与术前组相比，*P < 0.05
下载: 导出CSV
表 3 术前、术后2 d两组HCT （%），ALB （g/L），HCT-ALB比较（n = 44）
Table 3. Comparison of HCT，ALB and HCT-ALB between the two groups before surgery and 2 d after surgery （n = 44）
组别 HCT（%） ALB（g/L） HCT-ALB 术前 37.83 ± 7.12 33.26 ± 6.93 4.57 ± 8.22 术后2 d 30.79 ± 6.29* 22.48 ± 6.29* 8.32 ± 7.70* t 6.136 10.504 −2.527 P 0.000 0.000 0.015 与术前组相比，*P < 0.05
下载: 导出CSV
表 4 术前，术后7 d两组HCT （%），ALB （g/L），HCT-ALB比较（n = 74）
Table 4. Comparison of HCT，ALB and HCT-ALB between the two groups before surgery and 7 d after surgery （n = 74）
组别 HCT（%） ALB（g/L） HCT-ALB 术前 40.08 ± 6.85 34.04 ± 6.69 6.04 ± 7.61 术后7 d 33.92 ± 5.26* 25.73 ± 5.61* 8.20 ± 6.83* t 10.359 10.346 −2.699 P 0.000 0.000 0.009 与术前组相比，*P < 0.05。
下载: 导出CSV
表 5 术前，术后14 d两组HCT （%），ALB （g/L），HCT-ALB比较（n = 24）
Table 5. Comparison of HCT，ALB and HCT-ALB between the two groups before surgery and 14 d after surgery （n = 24）
组别 HCT（%） ALB（g/L） HCT-ALB 术前 38.75 ± 8.18 33.70 ± 8.41 5.05 ± 8.98 术后14 d 32.44 ± 4.55* 28.81 ± 6.72* 3.63 ± 6.12 t 4.705 2.285 0.765 P 0.000 0.032 0.452 与术前组相比，*P < 0.05。
下载: 导出CSV
表 6 术前，术后21 d两组HCT （%），ALB （g/L），HCT-ALB比较（n = 18）
Table 6. Comparison of HCT，ALB and HCT-ALB between the two groups before surgery and 21 d after surgery （n = 18）
组别 HCT（%） ALB（g/L） HCT-ALB 术前 41.83 ± 4.93 34.94 ± 7.19 6.89 ± 5.70 术后21 d 32.43 ± 3.81* 30.32 ± 5.30* 2.11 ± 5.18* t 7.014 2.480 3.678 P 0.000 0.024 0.002 与术前组相比，*P < 0.05。
下载: 导出CSV
表 7 好转组与死亡组年龄、性别HCT （%），ALB （g/L），HCT-ALB比较
Table 7. Comparison of age，gender，HCT，ALB and HCT-ALB between the improved group and the dead group
组别 年龄（岁） 性别（男/女） HCT（%） ALB（g/L） HCT-ALB 死亡组（18） 75.06 ± 7.99 13/5 42.43 ± 9.89 31.66 ± 5.74 10.77 ± 7.99 好转组（88） 68.69 ± 13.96 50/38 40.04 ± 6.31 34.48 ± 6.95 5.56 ± 7.16 t/χ2 2.580 1.471 0.982 −1.615 0.462 P 0.014 0.225 0.338 0.109 0.007
下载: 导出CSV
-
[1] 王鹏文,张文彬. 腹腔灌洗治疗重症腹腔感染65例分析[J]. 中国误诊学杂志,2002,2(10):1565-1565. doi: 10.3969/j.issn.1009-6647.2002.10.121 [2] Petersen M W,Perner A,Ravn F,et al. Untargeted antifungal therapy in adult patients with complicated intra‐abdominal infection:A systematic review[J]. Acta Anaesthesiologica Scandinavica,2018,62(1):6-18. doi: 10.1111/aas.13031 [3] Dai D M,Wang D,Hu D,et al. Difference in hematocrit and plasma albumin levels as an additional biomarker in the diagnosis of infectious disease[J]. Arch Med Sci,2020,16(3):522-530. doi: 10.5114/aoms.2019.86898 [4] Dai D M,Cao J,Yang H M,et al. Hematocrit and plasma albumin levels difference may be a potential biomarker to discriminate preeclampsia and eclampsia in patients with hypertensive disorders of pregnancy[J]. Clinica Chimica Acta,2017,464(1):218-222. [5] 代冬梅,唐坤,许汪斌,等. 系统性毛细血管渗漏综合征病程中血细胞比容与血浆白蛋白差值的变化:系统评价分析[J]. 中华危重病急救医学,2018,30(10):920-924. doi: 10.3760/cma.j.issn.2095-4352.2018.10.002 [6] 许汪斌,胡锐,王雨平,等. 白蛋白差值用于鉴别失血性休克和感染性休克的可行性研究[J].中华危重病急救医学,2018,30(12):1137-1140. [J]. 中华危重病急救医学,2019,31(12):1527-153. doi: 10.3760/cma.j.issn.2095-4352.2019.12.018 [7] 代冬梅,胡锐,许汪斌,等. 血细胞比容与白蛋白差值用于鉴别失血性休克和感染性休克的可行性研究[J]. 中华危重病急救医学,2018,30(12):1137-1140. doi: 10.3760/cma.j.issn.2095-4352.2018.12.007 [8] Marschner,Clara B,Wiinberg,et al. The influence of inflammation and hematocrit on clot strength in canine thromboelastographic hypercoagulability[J]. Journal of Veterinary Emergency and Critical Care,2018,28(1):20-30. doi: 10.1111/vec.12675 [9] 杨毅,邱海波. 《2004严重感染和感染性休克治疗指南》系列讲座(4)—糖皮质激素在感染性休克中的应用[J]. 中华危重病急救医学,2004,16(10):582-584. doi: 10.3760/j.issn:1003-0603.2004.10.003 [10] Kasie Fang,Chester L Bowen,John F Kellie,et al. Drug monitoring by volumetric absorptive microsampling:Method development considerations to mitigate hematocrit effects[J]. Bioanalysis,2018,10(4):241-255. doi: 10.4155/bio-2017-0221 [11] Walton Bethany L,Lehmann Marcus,Skorczewski Tyler,et al. Elevated hematocrit enhances platelet accumulation following vascular injury.[J]. Blood,2017,129(18):2537-2546. doi: 10.1182/blood-2016-10-746479 [12] Oberholzer A,Oberholzer C,Moldawer L L. Cytokine signaling:regulation of the immune response in normal and critically ill states[J]. Crit Care Med,2000,28(4 Suppl):3-12. -
