| Objective:To find the change of serum albumin in sepsis post-operation of endoscopic lithotripsy for urinary stone, and to find the change of early indicator. To investigate whether early fluid resuscitation and albumin supplementation can prevent the occurrence and improve the prognosis of septic shock and optimize the method of albumin supplementation.Methods:Clinical data:11 cases of septic shock after endoscopic lithotripsy for urinary calculi is from 2011 to 2016 in Sir Run Run Shaw Hospital. We compared the serum albumin concentration before and after septic shock. Animal experiment data:Firstly New Zealand rabbits were randomly divided into 5 groups, including group (ABCDE). Group A was injected saline to renal pelvis by 2ml/kg. Groups BCDE were injected E.coli 1.5*10^8cfu/ml,3.0*10^8cfu/ml,6.0*10^8cfu/ml,9.0*10^8cfu/ml, respectively, to monitor the preoperative and postoperative mean arterial pressure (MAP), serum albumin concentration. Secondly New Zealand rabbits were randomly divided into control group (F0,F1,GO,G1,H0,H1), all groups were injected E.coli 9.0*10^8cfu/ml to renal pelvis.2 hours after operation group (FO) was injected by 10ml of physiological saline, group (Fl) was injected by 10ml 20% albumin, group (HO) was injected by 2.5ml 20% albumin, group (H1) was injected by 10ml 5% albumin. Group (GO) was injected by 10ml 20% albumin 1 hour after operation, group (G1) was injected by 10ml 20% albumin 6 hour after operation, monitor and record mean arterial pressure (MAP) and survival time.Results:Clinical data:The serum albumin concentration after septic shock (27.3±3.1g/L) was significantly decreased compared to the serum albumin concentration before operation (P<0.01). Animal experiment data:There was no significant difference in mean arterial pressure between the group (A) and the group (B), group (C) in 6 hours after operation. On the contrary, the mean arterial pressure of the experimental group (D, E) decreased significantly after operation. Especially the mean arterial pressure of experimental group E postoperative 1 hour (67.17±1.49mmHg),2 hours (64.67± 0.80mmHg) were not significant different (P>0.05) compared with preoperative mean artery pressure (66.83±1.08mmHg),3 hours (6.1±0.89mmHg P<0.05),4 hours (54.17±0.54mmHg P<0.01) and 6 hours (45.17±0.75mmHg P<0.001) were significantly decreased compared to preoperative mean artery pressure. So we regard group(E) as the standard animal model. There was no significant change in serum albumin concentration for the group (A) in 6 hours after operation. But the serum albumin concentration of group (B, C, D, E) decreased gradually within 6 hours after operation. Especially in the experimental group E serum albumin concentration postoperative 1 hour (84.74%±0.90%),2 hours (81.75%±1.07%),3 hours (76.96%± 0.84%),4 hours (73.35%±1.246%),6hours (70.26%±2.94%) were significantly decreased compared to preoperative serum albumin concentration (P<0.001). Which suggested that postoperative serum albumin concentration decrease is positively correlated with the severity of the infection. Group (FO) shocked in 7-8 hours after operation and survived for 14.5±1.5 hours, group (F1) had no significant decrease of MAP and 100% survived for more than 48 hours, suggesting that early supplemental of albumin can improve the prognosis of urosepsis. Group (GO) had no significant decrease of MAP and 100% survived for more than 48 hours, Group (G1) shocked in about 6 hours after operation, but after the supplement of albumin, MAP rose up to normal level and maintain 7-9 hours before decreased again, finally survived for 22.2±2.8 hours. Which suggested that early(1-2hours after operation) supplemental of albumin was more effective. Group (HO) shocked in 6-7 hours after operation and survived for 12.0±1.2 hours, group (HI) shocked in 7-8.5 hours after operation and survived for 16.1±1.8 hours. Which suggested that the effect maybe better by using the low concentration of albumin when the amount of albumin is confirmed.Conclusion:Clinical data and animal models both suggest that the decrease of serum albumin is closely related to the severity of the infection. By monitoring serum albumin concentration can help determine urosepsis. Also the early (1-2hours affer operation) supplement of albumin may reduce the incidence of severe sepsis and septic shock, which ultimately improve the prognosis. Furthermore, the effect maybe better using the low concentration of albumin when the amount of albumin is confirmed. |
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