| Objective:To detect the content of 24-hour microalbuminuria,plasma albumn, total serum albumin, the levels of serum IL-6,TNF-abefore and after major abdominal surgery, explore the role of detecting microalbuminuria in systemic microcirculation leakage due to inflammatory response after early stage of moderate-Larger operations, thus provide a simple, economic and non-invasive method for montioring whether albumin leakage occurred in patients after surgery.Methods:This study included 30 patients, who had major abdominal surgerybetween March 2009 and Feb 2010 at the surgical ward of the Second Affiliated Hospital of Kunming Medicine Univerity. Among those patients 10 are of cholecystolithiasis and cholecystectomy,11 of Hepatectomy,9 of radical resection (2 of rectum carcinoma,5 of colon cancer,2 of pancreatoduodenectomy).All patients have been applied general anesthesia, POSSUM physiology (12 physiological indicator)was recorded Preopreative, POSSUM score of surgical trauma (include 6 indicator:operation size, operation times, blood loss, degree of abnominal infection, cancer and type of surgey) was recorded intraoperative. These patients are divided into three groups according to different types of operations applied, which are moderate-surgery group(8≤POSSUM score of surgical trauma<10), major-surgery group(POSSUM score of surgical trauma>11). At 24h,48h,72h before and after operation, the two groups have been tested on microalbuminuria,24-hour urine, plasma albumin concentration, plasma capacity, serum IL-6 and TNF-a concentration. The content of 24-hour microalbuminuria is calculated based on the microalbuminuria concentration and 24-hour urine; the content of plasma albumin of every patient is calculated based on plasma albumin concentration and plasma capacity.Results:1. Variations of the content of 24-hour microalbuminuria:①Comparison within the same group:3 days after surgey, the 24-hour microalbuminuria in the patients of two groups was increased than preoperation, the change has significant difference (moderate-surgery group F=204.22,P<0.05; major-surgery group F=40.05,P<0.05).The content of 24-hour microalbuminuria at 24h,48h,72h after operation show obvious decrease, and has siginficant difference compared with preoperation(P<0.05);②Comparison between the two groups:there is no significant difference at the content of 24-hour microalbuminuria before operation (P>0.05); while there is significant difference at the content of 24-hour microalbuminuria after operation(F=18.857,P<0.05);③The content of 24-hour microalbuminuria between two groups reached its highest value in the firt day after operation, but major-surgery group was significantly higher than those in moderate-surgery group.Variations of the content of total plasma albumin:①Comparison within thesame group:The content of total plasma albumin in the patients of two groups was decreased than preoperation, the change has significant difference (moderate-surgerygroup F=100.76,P<0.05; major-surgery group F=72.23,P<0.05). The content of total plasma albumin at 24h,48h,72h after operation show obvious decrease, and has siginficant difference compared with preoperation(P<0.05);②Comparison between the two groups:No significant difference in total plasma albumin between two groups preoperatively was found (P>0.05); The difference of total plasma albumin between two groups postoperatively was significant(F=14.32,P<0.05);③The content of total plasma albumin between two groups reached its lowestvalue in the 48h after operation, but major-surgery group was significantly lower thanthose in moderate-surgery group.3. Variations of the concentration of serum IL-6 and TNF-a:(1)Variations of the concentration of serum IL-6:①Comparison within the same group:The concentration of serum IL-6 in the patients of two groups was increased than preoperation, the change has significant difference (moderate-surgery group F=52.92,P<0.05; major-surgery group F=178.62,P<0.05); The concentration of serum IL-6 at 24h,48h,72h after operation show obvious increase, and has siginficant difference compared with preoperation(P<0.05);②Comparison between the two groups:No significant difference in serum IL-6 between two groups preoperatively was found (P>0.05); The difference of serum IL-6 between two groups postoperatively was significant (F=12.976, P＜0.05);③The concentration of serum IL-6 between two groups after operation increased and reached the peak in the 24h after operation, but major-surgery group was significantly higher than those in moderate-surgery group.(2) Variations of the concentration of serum TNF-a:①Comparison within the same group:The concentration of serum TNF-a in the patients of two groups was increased than preoperation, the change has significant difference (moderate-surgery group F=110.89,P<0.05; major-surgery group F=165.60,P<0.05); The concentration of serum TNF-aat 24h,48h,72h after operation show obvious increase, and has siginficant difference compared with preoperation(P<0.05);②Comparison between the two groups:No significant difference in serum TNF-a between two groups preoperatively was found (P>0.05); The difference of serum TNF-a between two groups postoperatively was significant(F=12.276,P<0.05);③The concentration of serum TNF-a between two groups after operation increased and reached its peak in the 48h after operation, but major-surgery group was significantly higher than those in moderate-surgery group.4. The firt day after surgey, the content of 24-hour microalbuminuria was positively correlated with POSSUM surgical trauma score(r=0.885, P< 0.05); the concent of 24-hour microalbuminuria was positively correlated with total serum albumin (r=-0.649, P< 0.05), and positively correlated with the concentration of serum IL-6 and serum TNF-a(.r=0.788, P< 0.05; r=0.643, P< 0.05)5. In the early stage after surgey, the concent of total serum albumin was negatively correlated with the concentration of serum IL-6 and serum TNF-a (r=-0.858, P< 0.05; r=0.951, P< 0.05), the concent of total serum albumin at 24h after surgey was negatively correlated with POSSUM surgical trauma score (r=-0.808, P< 0.05)Conclusion:The content of plasma albumin was decreased in the early stage after moderate abdominal surgery and major abdominal surgery, which negatively correlated with the concentration of serum IL-6 and serum TNF-a.Inflammatory medicator is an important factor to induce increased microvascular premeability,it lead to microvascular albumin leakage and cause hypoproteinemia in patients in the early stage after surgery.The content of 24-hour microalbuminuria was increased in the early stage after moderate abdominal surgery and major abdominal surgery, which negatively correlated with the the concent of total serum albumin, while positively correlated with the concentration of serum IL-6 and serum TNF-a, indicating that albumin leakage of renal microcirculation occurred; renal microcirculation as a part of systemic microcirculation, the reasons of albumin leakage in renal microcirculation was the same as the albumin leakage in systemic microcirculation, therefore, detection of microalbuminuria could be used as an indicator of whether albumin leakage in systemic microcirculation occurred.The firt day after surgey, the content of 24-hour microalbuminuria was positively correlated with POSSUM surgical trauma score, while the concent of total serum albumin was negatively correlated with POSSUM surgical trauma score. The content of 24-hour microalbuminuria of major-surgery group was significantly increased than that of moderate-surgery group, the the concent of total serum albumin of major-surgery group was significantly lower than that of moderate-surgery group, indicating that the greater the surgical trauma is, the more severe of microvascular albumin leakage in the early stage after surgey.
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