腹部手术后早期血浆白蛋白及炎症介质变化的研究

Early plasma albumin and inflammatory factors changes in patients undergoing abdominal surgery

目的 探讨不同腹部手术后早期是否存在血浆白蛋白含量降低及术后早期血浆白蛋白含量变化是否与炎症介质水平相关.方法 选取2008年8月至2009年3月择期行不同腹部手术的患者45例,按手术方式不同将患者分为胆囊切除组（A组）、胆囊切除＋胆道探查组（B组）、消化道肿瘤根治切除组（C组）.每组均为15例.3组于术前、术后12、24、48 h及72 h测定血浆白蛋白含量、血清IL-6、TNF-α浓度.结果 白蛋白含量：A组术后各检测时间点较术前无明显降低（P＞0.05）;术后各检测时间点B、C组患者血浆白蛋白含量较术前降低（P＜0.01）,C组下降更明显.血清IL-6、TNF-α：A组患者术后12、24、48 h较术前升高（P＜0.01）;B、C组患者术后各检测时间点较术前升高（P＜0.01）;术前3组间比较差异无统计学意义（P＞0.05）.术后各检测时间点3组间比较差异有统计学意义（P＜0.01）.血浆白蛋白含量与IL-6、TNF-α浓度呈负相关;（r=-0.376,P=0.000;r=-0.772,P=0.000）.结论 腹部中大手术后早期患者出现血浆白蛋白含量降低;腹部手术后早期炎症介质有不同程度的升高;腹部手术后早期白蛋白含量与炎症介质浓度呈负相关.

Objective To probe the changes of plasma albumin concentration and its correlation with that of blood inflammatory factors at the postoperative early stage in patients undergoing intraabdominal surgery. Methods From August 2008 to March 2009, 45 patients undergoing abdominal surgery were divided into three groups according to different types of operation with 15 cases in each group, cholecystectomy group（ A）, chole cystectomy plus common bile duct exploration group（B） and radical resection of alimentary duct maliguance group （C）. Before the surgery and 12,24,48,72 h after operation, plasma albumin contentserum IL-6 and TNF-α concentration were measured. Results Postoperatively the content of plasma albumin did not change significantly in group A （ P 〉 0.05 ）, while that decreased after operation in group B and group C（P 〈0.01 ）. The postoperative concentration of serum IL-6 and TNF-α increased in group A at 12, 24 h and 48 h after operation（P 〈0.01 ）. In group B and group C IL-6 and TNF-α increased at all tested time point after operation （ P 〈 0.01 ）. The postoperative alterations of IL-6 and TNF-α were statistically different between the three groups at all time points（P 〈0.01 ）. The content of plasma albumin was in a negative correlation with the concentration of IL-6 and TNF-α; （ r = - 0.376, P = 0.000; r =-0.772,P = 0.000）. Conclusions The content of plasma albumin decreased at the early stage after major and moderate abdominal surgery. The content of plasma albumin was in a negative correlation with the concentration of inflammatory factors at the early stage after abdominal surgery.