Analysis Of Influencing Factors Of Severe Hypoproteinemia In Postoperative Non-infected Patients

Objective: To analyse and explore the main risk factors of severe hypoproteinemia in Postoperative non-infected patientsMethods: Retrospective analysis of the Second Affiliated Hospital of Kunming Medical University, Department of intensive care unit (ICU) from March 2016 to July 2016 treated 203 postoperative cases,which did not diagnose of infection preoperative, intraoperative and postoperative 24 hours .Collect the general condition of the patient (age, height, weight, sex), basal disease (hypertension, diabetes ),serum albumin concentration preoperative and postoperative within 1 hour, operation time,operation mode,whether use of vasoactive drugs,blood loss,rehydration volume (total infusion volume, crystal volume, colloid volume, plasma volume) in surgery and so on. According to the postoperative serum albumin concentration, the cases were divided into two groups, namely, severe hypoproteinemia group (ALB<25 g/L) ) and control group (ALB?25 g/L ). Reference to the relevant literature and clinical experience, fifteen causes of postoperative hypoproteinemia were selected.SPSS 19.0 software was used for statistical analysis, counting data using chi-square test and measurement data using t-test or analysis of variance . Multivariate logistic regression was used to perform multivariate regression analysis.Then, Spearman rank correlation analysis was used to analyse the relationship between the degree of postoperative albumin decline and intraoperative rehydration (total infusion volume,crystal volume, colloid volume, plasma volume), blood loss, surgical time.Multivariate linear regression analysis was performed on statistically significant data to get the predicted factors.Results: A total of 203 cases of preoperative, intraoperative and postoperative 24 hours unidentified infections were collected. Including male 113 cases and female 90 cases,aged 2-89 years,mean (54.72± 18.20) years old. After surgery the serum albumin concentration was significantly decreased from (39.04±6.06) g / L to (22.87±5.62) g / L. After surgery the decrease of albumin was (16.17 ± 6.74) g / L, that is,the difference between preoperative albumin and albumin within 1 hour after surgery.Postoperative the incidence of hypoalbuminemia( ALB<35g/L) was as high as 97%,and the incidence of severe hypoalbuminemia (ALB<25 g/L ) was about 68%.Univariate statistical analysis showed that there was significant difference between severe hypoproteinemia group and control group in whether combination with hypertension, hypoalbuminemia preoperative , surgical methods, operation time, total infusion volume per kilogram, crystal per kilogram, colloid per kilogram, blood loss per kilogram and whether use of vasoactive drugs (p <0.05); There was no significant difference between the two groups in Sex, age, diabetes mellitus, plasma volume per kilogram, lactate value and oxygenation index(p> 0.05). Multivariate logistic regression analysis showed that preoperative albumin and colloidal volume per kilogram were risk factors for postoperative severe hypoalbuminemia. Spearman rank correlation analysis showed that there was a positive correlation between the degree of albumin decline and total infusion volume per kilogram, crystal per kilogram,colloid per kilogram, blood loss per kilogram and operation time(p <0.05), but with plasma volume per kilogram no statistically relevant (p > 0.05). The degree of albumin decline with colloid per kilogram has a moderate correlation (r = 0.404), the remaining with low correlation ( r<0.4 ) . Multivariate linear regression analysis showed that blood loss per kilogram (X1, ml/kg) and colloidal volume per kilogram(X2,ml/kg) were predictors of albumin decline (Y, g/L) , the regression equation was Y= 10.919-0.093X1+0.245X2.Conclusion:1. Non-infected patient's albumin concentration was significantly decreased(from 39.04 g / L to 22.87 g/L) after surgery, the incidence of hypoalbuminemia was as high as 97%, and the incidence of severe hypoalbuminemia was about 68%.2. Preoperative albumin and colloidal volume per kilogram were risk factors for postoperative severe hypoalbuminemia.3. Blood loss per kilogram and colloidal volume per kilogram were predictors of albumin decline value.