术后低蛋白血症与补充人血白蛋白对卵巢癌手术切口愈合不良的影响

Effect of postoperative hypoproteinemia and supplement of human serum albumin on the development of poor wound healing following ovarian cancer surgery

目的分析卵巢癌开腹术后低蛋白血症与切口愈合不良间的关系,以及术后补充人血白蛋白(HSA)是否有利于改善切口愈合。方法回顾性分析2019年6月至2021年12月在西南医科大学附属医院妇科行卵巢恶性肿瘤开腹手术的122例患者临床资料。收集患者基本资料(年龄、体重指数、基础疾病、术前实验室检查结果、肿瘤分期)、手术资料(美国麻醉师协会分级、手术时间、出血量)、术后资料(术后低白蛋白血症发生情况、抗生素使用时间、术后转重症监护室情况、输入HSA量、围手术期输血量、住院30 d内切口愈合不良情况)等,分析术后切口愈合不良的发生率及术后发生切口愈合不良的影响因素。采用多因素logistic回归分析模型调整混杂因素后分析术后输入HSA与切口愈合不良的相关性。结果共46例(37.70%)患者住院30 d内发生切口愈合不良。相较于未发生切口愈合不良患者,发生切口愈合不良患者术前血红蛋白水平更高,术后白蛋白水平更低,手术时间更长,出血量更多,差异均有统计学意义(P<0.05);其他资料均无明显差异(P>0.05)。单因素分析显示,术前血红蛋白水平(OR=1.033,95%CI:1.006~1.060,P=0.017)、术后白蛋白水平(OR=0.921,95%CI:0.862~0.985,P=0.016)及手术时间(OR=1.004,95%CI:1.001~1.007,P=0.013)均与切口愈合不良有关。多因素logistic回归分析模型调整混杂因素后显示,术后输入HSA量与发生切口愈合不良无明显相关性(P>0.05)。结论卵巢癌开腹术后补充HSA并不能改善切口愈合情况。

Objective To analyse the association between postoperative hypoproteinemia and poor wound healing,and to evaluate whether postoperative supplementation of human serum albumin(HSA)can improve wound healing after laparotomy.Methods Clinical data of 122 patients who underwent laparotomy for ovarian malignant tumor in the Department of Gynecology,Affiliated Hospital of Southwest Medical University from June 2019 to December 2021 were retrospectively analyzed.All patients’basic information(including age,body mass index,basic diseases,preoperative serum laboratory values,and neoplasm staging),surgical information(including American Society of Anesthesiologist grade,operative time,blood loss),and postoperative data(including occurrence of postoperative hypoalbuminemia,duration of antibiotic use,postoperative transfer to intensive care unit,amount of HSA supplementation,perioperative blood transfusion,and poor wound healing within 30 days of hospitalization)were reviewed.The incidence and influencing factors of postoperative poor wound healing were analyzed.Multivariate logistic regression model was performed with adjustment for potential confounding factors to analyze the correlation between postoperative supplementation of HSA and poor wound healing.Results Poor wound healing occurred in 46(37.70%)patients within 30 days of hospitalization.Compared with patients without poor wound healing,patients with poor wound healing had higher preoperative hemoglobin level,lower postoperative albumin level,longer operative time,and more blood loss,and the differences were statistically significant(P<0.05).And there was no significant difference in other data(P>0.05).The results of univariate analysis showed that the preoperative hemoglobin level(OR=1.033,95%CI:1.006-1.060,P=0.017),postoperative albumin level(OR=0.921,95%CI:0.862-0.985,P=0.016)and operative time(OR=1.004,95%CI:1.001-1.007,P=0.013)were associated with poor wound healing.The results of multivariate analysis with adjustment for potential confounding factors showed that there was no correlation between postoperative supplementation of HSA and poor wound healing(P>0.05).Conclusion Supplementation of HSA after laparotomy for ovarian cancer can’t improve wound healing.