术后低白蛋白血症与补充人血白蛋白对腰椎内固定术后发生切口愈合不良的影响

Effect of postoperative hypoalbuminemia and supplement of human serum albumin on the development of poor wound healing following lumbar internal fixation surgery

目的分析腰椎内固定术后低白蛋白血症与切口愈合不良之间的相关关系并探讨术后补充人血白蛋白是否改善术后切口愈合情况。方法选取2014年1月到2018年12月在南方医科大学珠江医院骨科行后路腰椎内固定手术的602例患者为研究对象,其中男250例(41.5%),女352例(58.5%),平均年龄为(60±12)岁。收集患者基本资料、术前检验结果、手术资料、术后检验结果、术后切口愈合情况等信息,评估术后切口愈合不良的发生率。运用R软件及Empower(R)软件分析术后切口愈合不良的影响因素。运用多元回归分析模型调整混杂因素后分析术后低白蛋白血症以及补充人血白蛋白与切口愈合不良的相关性。结果共有51例(8.47%)出现术后切口愈合不良。调整混杂因素后,多元回归分析结果提示术后白蛋白水平与切口愈合不良无相关性(OR=1.00,95%CI:0.91~1.10,P=1.000)。与术后白蛋白水平正常者相比,术后低白蛋白血症患者切口愈合不良的风险增加了13%(OR=1.13,95%CI:0.47~2.70,P=0.787)。无论是在术后白蛋白水平正常的患者还是术后低白蛋白血症的患者,补充人血白蛋白与切口愈合不良皆不存在相关性(均P>0.05)。结论腰椎内固定术后低白蛋白血症与切口愈合不良之间无相关性;同时,术后补充人血白蛋白并不能改善切口愈合情况。

Objective To analyze the association between postoperative hypoalbuminemia and poor wound healing,and to evaluate whether postoperative supplementation of human serum albumin can improve postoperative wound healing after lumbar internal fixation surgery.Methods From January 2014 to December 2018,602 patients who underwent lumbar internal fixation surgery in the Department of Orthopedics,Zhujiang Hostiptal of Southern Medical University were identified.There were 250 males(41.5%)and 352 females(58.5%),with an average age of(60±12)years.All patients′clinical records were reviewed,including demographics data,comorbidity data,preoperative serum laboratory values,intraoperative factor,postoperative serum laboratory values and wound healing,and the incidence rate of poor wound healing was calculated.The statistical analyses were performed with R software and Empower(R)to analyze the factors related to poor wound healing.Multiple logistic regression models were performed with adjustment for the potential confounders to evaluate the effect of postoperative hypoalbuminemia and supplementation of human serum albumin on the development of poor wound healing.Results Poor wound healing occurred in 51(8.47%)patients.After adjusting for the confounding factors,multiple regression analysis showed that there was no correlation between postoperative albumin levels and poor wound healing(OR=1.00,95%CI:0.91-1.10,P=1.000).Compared with patients with postoperative normal albumin level,postoperative hypoalbuminemia would increase the risk of poor wound healing by 13%(OR=1.13,95%CI:0.47-2.70,P=0.787).There was no correlation between supplementation of human serum albumin and poor wound healing in patients with normal albumin levels or postoperative hypoalbuminemia(P>0.05).Conclusions There is no correlation between postoperative hypoalbuminemia and poor wound healing after lumbar internal fixation surgery.Postoperative supplementation of human serum albumin can′t improve wound healing.