心脏瓣膜患者术后临床结局与血浆白蛋白关系的研究  

Relationship between serum albumin level and clinical outcome in patient with heart valve operation

作　　者：夏萌[1,2] 王文美[1,2] 郝佳音[1,2] 康倩[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所临床营养科,北京100029

出　　处：《心肺血管病杂志》2011年第4期316-318,350,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨心脏瓣膜患者术前、术后低蛋白血症对临床结局的影响。方法:2010年10月至2011年1月在我院心外科住院手术的心脏瓣膜病变患者154例,全部检查入院白蛋白(ALB)、术后每w查ALB,以出院前最后一次ALB作为术后ALB指标。ALB≥35 g/L为正常白蛋白组,<35 g/L为低白蛋白组。临床结局项目包括:术后住院时间,监护室停留时间,是否发生感染,是否二次手术,转归是否不良及住院费用。结果:术前ALB≥35 g/L组与<35 g/L组比较,在临床结局上差异无统计学意义(P>0.05);术后ALB水平与临床结局关系十分密切,ALB<35 g/L的患者术后住院时间和监护室停留时间比≥35 g/L患者明显延长(P<0.01),不良转归的发生率和感染的发生率明显高于ALB≥35 g/L的患者,二次手术及住院费用方面差异无统计学意义(P>0.05)。去除术前低蛋白血症的病例,这种趋向仍很明显。相关分析显示:术前ALB水平与患者术后住院时间呈负相关(r=-0.124,P=0.038);术后ALB水平与术后住院时间、监护室停留时间呈负相关(r=-0.544,P=0.0001和r=-0.198,P=0.001)。结论:在关注心瓣膜患者术前营养状态的同时,要特别关注心瓣膜病患者术后的营养状态,术后出现低ALB是影响心脏瓣膜手术病患者临床结局的重要因素之一。Objective：To study the effect of lower serum albumin level（before and after operation） to clinical outcome in the patient with heart valve surgery.Methods： A cross sectional study was carried out in 154 patients being hospitalized with heart valve operation between October 2010 and January 2011.The serum albumin（ALB） was examined at admission and once a week after operation.The last ALB before patient leaving hospital was defined as after operation ALB level.The clinical outcome was compared between lower ALB group（ALB 35 g/L） and normal ALB group（ALB≥35 g/L）.The clinical outcome include hospital stays postoperative,time of stay in the intensive care units（ICU）,infection or not,reopevation or not,If adverse prognosis or not and hospitalization expense.Results：Compared between ALB≥35 g/L group with ALB35 g/Lgroup at admission,there were not difference in clinical outcome.The ALB level after operation had close relations with clinical outcome.ALB35 g/Lgroup was significantly longer in hospital stays after operation and length of stay in ICU than ALB≥35 g/L group（P0.01）,In addition,the incidence of adverse prognosis and rate of infection were higher than ALB≥35 g/L group.The rate of second operation and hospitalization expense were not statistical different.To remove lower ALB cases before operation,this tendency was also evident.The correlation analysis showed that the level ALB at admission was negative related to the hospital stays after operation（r=-0.124,P=0.038）;and the level of ALB after operation were negative related to the hospital stays after operation and length of stay in ICU（r =-0.544,P=0.000 and r=-0.198,P=0.001）.Conclusion： Lower ALB level after operation is important factor to outcome for patient with heart valve operation.

关 键 词：心脏瓣膜病 心脏外科手术 低蛋白血症 临床结局 

分 类 号：R542.5[医药卫生—心血管疾病]