Correlation Analysis Of Microalbuminuria And Complications After Abdominal Operation

BackgroundTrauma is one of the most common clinical emergency, with the key point of abdominal trauma. The incidence rate in everyday life is about 0.4%-1.8% of various injuries. Most patients require emergency surgery because of the traumatic condition, while problems such as complex injuries, acute illness, severe abdominal contamination, and high occurrence of postoperative complications call for clinicians' attention. So, preventing complications after surgery is one of the important factors to improve the success rate of rescue.In recent years, capillary leak syndrome(CLS) receives much concern. Under normal physiological conditions, water and electrolytes free access interstitial spaces in the role of osmotic pressure in and out the blood vessels, while the plasma protein cannot pass the capillary barrier. When the body under pathological conditions, such as severe trauma, sepsis, burns, acute lung injury or acute respiratory distress syndrome(ARDS), the toxic effects of drugs, etc. capillary permeability will increase, small molecular substances will ooze, performing hypoalbuminemia, hypovolemic shock, progressive edema series and so on. In the early after surgery, as surgical stress induce the body's inflammatory response, increasing permeability of microcirculation, albumins leakage into the interstitial space, serum albumin levels decrease. At the same time, the renal microcircular permeability changes more obvious. According to several studies about microalbuminuria(MAU) positive patients with hypertension and diabetes, most scholars believe, MAU is a significant manifestation of systemic vascular endothelial dysfunction in these patients. Therefore, MAU could be used as indicators of microcirculation leakage of postoperative abdominal injuries, which is proposed since 1980 s.It has been proved that the pathogenesis of complications after abdominal injury and CLS had close relationship. The urinary albumin is one of the clinical parameters, which is most commonly used to reflect the increased capillary permeability in the international. However, studies about MAU predicting prognosis of abdominal injury are absence, correlation between MAU and abdominal surgery complications is unknown. ObjectiveBy detecting microalbuminuria of 102 patients after abdominal trauma surgery, this study explore the role and significance of the change in postoperative inflammation caused by systemic microcirculation albumin leakage, and the correlation of microalbuminuria and complications after abdominal operation postoperative patients. By comparing with the POSSUM scores, it provide a simple, economical, non-invasive detection and prognostic indicators for the occurrence and prognosis of abdominal injury patients' postoperative complications. Methods102 patients with abdomen operation were treated in surgery emergency of the first affiliated hospital of zhengzhou university between January 2012 to December 2014. The correlation of microalbuminuria and complications after abdominal operation were analyzed retrospectively. With surgeries of splenectomy(15 cases), liver repair(6 cases), cholecystectomy(two cases), pancreatic suture(5 cases), duodenal repair(7 cases), pancreaticoduodenectomy(3 cases), gastric repair(12 cases), intestinal repair(18 cases), intestinal resection and anastomosis(16 cases), intestinal ostomy(18 cases). All patients were given abdominal trauma emergency surgery with general anesthesia. Preoperative record POSSUM physiology score(12 physiologic), intraoperative record POSSUM surgical trauma score(comprising six indicators: size of operation, operative times, intraoperative blood loss, abdominal pollution, cancer, surgery category) and calculate the total score of each patient. Patients were divided into two group, with complications and without complications. Blood routine, urine albumin, serum albumin(ALB), blood urea nitrogen(BUN), serum creatinine(Cr) levels of two groups of patients were tested in the preoperative, urine microalbuminuria, urine creatinine and renal function were checked at 24, 48 and 72 h after surgery, calculating urinary albumin / urinary creatinine ratio(ACR) at the same time. Aim to investigate the correlation between ACR, POSSUM and postoperative complications of abdominal injuries, and compare the predictive value of ACR and POSSUM. Results 1. There were no statistical significance in preoperative general conditions and ACR between group with complications and group without complications. 2. Urinary albumin / urinary creatinine ratio(ACR) at 24, 48 and 72 hours was significantly higher in patients with postoperative complications than in those without complications. 3. According to POSSUM, complications group had a higher score of physiology and operative severity, comparing with patients without complications, the difference was significant. 4. On the ROC curve, MAR24, MAR48 and POSSUM score in occupied area under the curve were respectively 0.893, 0.946 and 0.902. Conclusion 1. Urinary albumin have good correlation with complications after surgery, can accurately predict post-operative abdominal injury incidence of complications. 2. Urinary albumin and POSSUM scoring system can objectively determine the severity of disease, predict prognosis and guide clinical treatment. 3. Comparing with POSSUM scoring system, microalbuminuria is a more simple, rapid, non-invasive and reliable predictor in patients after abdominal injury prognosis. 4. If we can find a point connect urinary albumin and POSSUM scoring system, might it can be better applied to the prognosis of patients after abdominal injury surgery. That is the question need to be further studied.