麻醉重症监护病房非心脏手术患儿术后发生低蛋白血症的危险因素

Risk factors for postoperative hypoproteinemia in AICU children without cardiac surgery

目的 分析麻醉重症监护病房(AICU)非心脏手术患儿术后发生低蛋白血症的危险因素。方法 回顾性收集手术后入住AICU的患者数据。采集指标包括基本资料(如性别、年龄、诊断、术前血红蛋白、白蛋白及总蛋白等)、术中资料(如手术名称、术中出血量、术中输液总量、输注血制品种类及数量)和术后资料(如术后血红蛋白、白蛋白、总蛋白)。根据术后第一次白蛋白值分为术后低蛋白血症组(观察组)和术后无低蛋白血症组(对照组),主要结局指标为术后低白蛋白血症(≤30 g/L)的发生率。采用多因素logistic回归分析筛选低白蛋白血症的危险因素。结果 符合入选标准患儿共544例,年龄从1 d至14岁5个月,中位数年龄13.19个月,低白蛋白血症发生率为17.3%(94/544)。与对照组患者比较,观察组术前白蛋白水平低于对照组,且该组患者手术时间更长、术中输红细胞量更大、输液总量更多、输液速度更快。多因素logistic回归分析显示,术中输液速度(OR=1.037,95%CI1.004~1.072,P=0.029)以及手术种类中的肠道手术(OR=4.854,95%CI 1.076~21.898,P=0.040)、胸科手术(OR=10.548,95%CI 2.757~40.35,P<0.001)、眼科手术(OR=7.825,95%CI 1.89~32.395,P=0.005)都与术后低蛋白血症发生风险增加相关,而术前血红蛋白量(OR=0.976,95%CI 0.961~0.992,P=0.004)和白蛋白含量(OR=0.827,95%CI 0.776~0.882,P<0.001)越高则与术后低蛋白血症风险降低相关。结论 低蛋白血症是小儿外科术后常见并发症,多因素分析显示肠道手术、胸科手术、眼科手术及术中输液速度会增加其发生风险,而术前高血红蛋白和高白蛋白血症与其发生风险降低有关。

Objective To analyze the risk factors of postoperative hypoproteinemia in AICU children without cardiac surgery.Methods Data of patients admitted to AICU after operation were retrospectively collected.Basic information,including gender,age,diagnosis,preoperative hemoglobin,albumin and total protein,etc.;intraoperative data,including operation type,intraoperative blood loss,intraoperative infusion amount,type and quantity of blood products usage;and postoperative data,including postoperative hemoglobin,albumin and total protein were recorded.According to the first postoperative albumin value,they were divided into observation group(postoperative hypoalbuminemia group)and control group,in which patients without postoperative hypoalbuminemia.The main outcome index was the incidence of postoperative hypoalbuminemia(≤30 g/L).Multivariate logistic regression analysis was used to screen risk factors for hypoalbuminemia.Results A total of 544 patients were eligible.The children age from 1 day to 14 years and 5 months,with a median age of 13.19 months.The incidence of hypoalbuminemia was 17.3%(94/544).The preoperative albumin level in the hypoalbuminemia group was lower than that in the control group,with longer operation time,more intraoperative erythrocyte transfusion,more total infusion volume,and faster infusion speed.Multivariate logistic regression analysis showed that intraoperative infusion speed(OR=1.037,95%CI:1.004-1.072,P=0.029)and intestinal surgery(OR=4.854,95%CI:1.076-21.898,P=0.040),chest surgery(OR=10.548,95%CI:2.757-40.35,P<0.001),and eye surgery(OR=7.825,95%CI:1.89-32.395,P=0.005)were associated with increased risk of postoperative hypoproteinemia.The higher preoperative hemoglobin level(OR=0.976,95%CI:0.961-0.992,P=0.004)and albumin level(OR=0.827,95%CI:0.776-0.882,P<0.001)were associated with a lower risk of postoperative hypoproteinemia.Conclusion Hypoproteinemia is a common complication after pediatric surgery.Intestinal surgery,chest surgery,ophthalmic surgery and high intraoperative infusion speed can increase the risk of hypoproteinemia,while preoperative hyperhemoglobin and hyperalbuminemia reduce the risk.