严重脓毒症患儿低白蛋白血症的动态监测及其临床意义探讨

Clinical significance of dynamic hypoalbuminemia monitoring in children with severe sepsis

目的分析低白蛋白血症在严重脓毒症患儿中的发生情况及其与预后的关系，并探讨其发生的原因与处理对策。方法2010年8月至2011年9月在我院小儿重症医学科诊断为严重脓毒症的患儿75例，依据入院24h内及入院第3天、第7天血清白蛋白水平，分为低白蛋白血症组和血清白蛋白正常组，并将低白蛋白血症组分为持续低白蛋白血症组和即刻低白蛋白血症组，分析低白蛋白血症及其持续时间与预后的关系，探讨发生低白蛋白血症的主要原因及处理对策。结果（1）发生低白蛋白血症患儿63例（84．0％），其中死亡／放弃21例（病死率33．3％）；血清白蛋白正常组12例（16．0％），无死12／放弃病例。（2）63例低白蛋白血症患儿中，持续低白蛋白血症37例，死亡／放弃17例（病死率46．0％）；即刻低白蛋白血症26例，死12／放弃4例（病死率15．4％），持续低白蛋白血症组病死率明显高于即刻低白蛋白血症组（χ2=5．116，P〈0．05）。（3）63例低白蛋白血症患儿中，存在肝功能损害32例，死亡／放弃12例（病死率37．5％）；毛细血管渗漏13例，死亡／放弃3例（病死率23．1％）；肝功能损害并毛细血管渗漏18例，死亡／放弃6例（病死率33．3％），不同因素所致低白蛋白血症患儿的病死率比较差异有统计学意义（χ2=7．812，P〈0．05）。结论低白蛋白血症影响严重脓毒症患儿的预后，持续时间越长，预后越差。肝功能损害、毛细血管渗漏是低白蛋白血症的重要原因，及时、有效地处理各种原因引起的低白蛋白血症能明显改善严重脓毒症患儿的预后。

Objective To study serum albumin levels in children with severe sepsis and to correlate serum albumin levels with patient outcome and to identify the causes inducing hypoalbuminemia and its effective countermeasures. Methods Seventy-five children admitted to PICU of Provincial Hospital Affiliated to Shandong University for severe sepsis were included in the study from Aug 2010 to Sep 2011. According to their serum albumin levels within 24 hours and on the third and the seventh day of admission to PICU, 75 children were divided into hypoalbuminemia group and normal serum albumin group. Then hypoalbuminemia group was divided into instant hypoalbuminemia group and continuous hypoalbuminemia group according to the duration of hypoalbuminemia. The correlation between the occurring and duration of hypoalbuminemia with patients＇ prognosis,the etiopathogenisis of hypoalbuminemia and its effective countermeasures were analyzed. Results （ 1 ） Sixty-three cases （ 84. 0% ） proceeded hypoalbuminemia and their mortality was 33.3 % （21/63） ,while 12 cases （16. 0% ） showed normal serum albumin level and their mortality was 0. （2） In 63 patients with hypoalbuminemia, 26 cases showed continuous hypoalbuminemia and their mortality was 46. 0%, while 37 cases proceeded instant hypoalbuminemia and their mortality was 15.4%. There was signif- icant difference （ χ2 = 5. 116, P 〈 0. 05 ） between their mortality. （ 3 ） In the 63 cases with hypoalbuminemia, 32 cases presented with hepatic injury and their mortality was 37. 5% , 13 cases proceeded capillary leakage and their mortality was 23. 1% ,and 18 cases displayed hepatic injury complicated with capillary leakage and their mortality was 33.3%. There was significant difference （χ2= 7. 812, P 〈 0.05 ） between the mortality with different causes. Conclusion Hypoalbuminemia influenced the prognosis of children with severe sepsis ,the longer duration correlated with the worse prognosis. Hepatic injury and capillary leakage were two main causes inducing hypoalbuminemia. Active treatment of hypoproteinemia aimed directly at different causes could improve their prognosis significantly.