术后早期白蛋白降低对结直肠癌术后手术部位感染的预测价值  

The value of early postoperative albumin reduction in the prediction of surgical site infection after colorectal cancer surgery

作　　者：朱永龙[1] 顾国胜[2] 翁延宏 刘爱彬 ZHU Yong-long;GU Guo-sheng;WENG Yan-hong;LIU Ai-bin(Department of general surgery, Anhui Huangshan Shoukang Hospital, Huangshan 245000, Anhui, China;Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine~anjing General Hospital of Nanjing Military Region, PLA, Nanjing 210002, Jiangsu, China)

机构地区：[1]安徽省黄山市首康医院普通外科,安徽黄山245000 [2]南京大学医学院临床学院南京军区南京总医院普通外科研究所,江苏南京210002

出　　处：《肠外与肠内营养》2018年第3期151-155,共5页Parenteral & Enteral Nutrition

摘　　要：目的:探讨术后早期监测血清白蛋白(ALB)的变化在预测结直肠肿瘤发生手术部位感染(SSI)中的价值。方法:收集2015年5月至2016年5月收治的169例结直肠手术病人,根据术后是否出现SSI将病人分为有SSI组及无SSI组。术后三天连续性采集静脉血行ALB、CRP、PCT、WBC检查,评价白蛋白变化与术后SSI的关系。结果:有SSI共40例(23.7%),临床诊断SSI的时间平均为术后3.2天。SSI组术后第2天血清白蛋白下降,PCT、CRP和WBC水平升高。术后第2天的白蛋白浓度下降比例(ΔALB2)明显高于SSI组(P<0.001)。ROC曲线分析显示,ΔALB2对预测SSI的发生具有显著价值(曲线下面积=0.864,灵敏度97.5%,特异度70.5%),最佳临界值为15.5%。多元回归分析显示,ΔALB2>15.5%是预测SSI发生的独立因素(OR=2.10,95%CI=1.52-2.90,P<0.001)。结论:监测术后早期白蛋白的动态变化对预测结直肠癌切除术后SSI的发生有重要的价值。Objective： To investigate the value of early postoperative monitoring of serum albumin in the prediction of surgical site infection（SSI） in colorectal cancer surgery. Methods： A total of 169 patients undergoing colorectal cancer surgery between December 2012 and January 2016 were collected for this study. Patients was divided into SSI group and no SSI group according to whether SSI occurred after surgery. We continuously collected venous blood three days after surgery. Serum albumin, C-reactive protein level, Procalcitonin and White blood-cell were performed to evaluate the relationship between albumin changes and postoperative SSI. Results： There were 40 cases（23.7%） of SSI, and the average time for clinical diagnosis of SSI was 3.2 days after surgery. ALB decreased, and PCT, CRP, and WBC levels increased in the SSI group on the second postoperative day. The decrease in albumin concentration（ΔALB2） was significantly higher on the second postoperative day than in the SSI group（P 〈0.001）. Receiver-operating characteristics（ROC） curve analysis showed that ΔALB2 had significant value in predicting the occurrence of SSI（area under the curve = 0.864, sensitivity 97.5%, specificity 70.5%）, and the optimal cutoff was 15.5%. Multiple regression analysis showed that ΔALB2〉 15.5% was an independent predictor of SSI（OR=2.10, 95%CI=1.52-2.90, P〈 0.001）. Conclusions： The dynamic change of serum albumin is valuable to predict the occurrence of SSI after colorectal cancer surgery.

关 键 词：白蛋白降低 手术部位感染 结直肠癌 

分 类 号：R735.3[医药卫生—肿瘤]