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頁籤選單縮合
題名 | Serum Albumin Contentration as a Prognostic Indicator for Acute Surgical Patients=血清白蛋白濃度可作為外科重症病人的一個預後指標 |
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作者 | 龔松保; 唐高駿; 吳秋文; 雷永耀; | 書刊名 | 中華醫學雜誌 |
卷期 | 62:2 1999.02[民88.02] |
頁次 | 頁61-67 |
分類號 | 416.351 |
關鍵詞 | APACHE Ⅱ積分; 預後; 血清白蛋白濃度; APACHE Ⅱ score; Outcome; Serum albumin concentration; |
語文 | 英文(English) |
中文摘要 | 背景:對於體內能量不足的外科重症病人,其血清白蛋白濃度之迅速下降是否與 預後相關,迄今仍缺乏研究。 方法: 回顧 7 個月內 80 位在臺北榮民總醫院外科加護中心顯示有體內能量不足之新病人 ,用單變數及多變數的分析方法來探討他們的年齡、性別、診斷、住重症加護中心的原因和 天數、白蛋白注射、高能營養治療、APACHE II 積分、 血清白蛋白濃度與 3 個月內病人預 後的關係。 結果:由單變數分析可知, 血清白蛋白濃度及 APACHE II 積分均影響外科重症病人的存活 ,p 值分別是 0.002 及 0.025。 而多變數分析則發現,僅血清白蛋白濃度偏低能獨立影響 病人的存活 (p =0.003)。單純提供高能營養及注射白蛋白都未能有效改善存活率。 結論:研究顯示,血清白蛋白是外科重症病人存活的良好指標。雖然血清白蛋白下降也可能 反映營養不良的狀態,但對於中至重度血清白蛋白濃度偏低而沒有其它指標顯示營養不良的 重症病人,單純輸入白蛋白及營養支持療法能有效地改善存活率。因此,積極尋找白蛋白降 低的原因且及早治療或許更為重要。 |
英文摘要 | Background. Whether or not the rapid reduction in serum albumin concentration in acute surgical patients without evidence of pre-existing energy deficit correlates with outcome has yet to be studied. In this study, we attempted to determine whether albumin infusion or nutritional supplementation can improve outcome for patients with hypoalbuminemia. Methods. We retrospectively reviewed 80 non-calorie-deficient patients newly admitted to the surgical intensive care unit of the Veterans General Hospital-Taipei with complete data for serum albumin concentration and APACHE II score within 24 hours from August, 1993, to February, 1994. The relationships between age, sex, diagnosis, reason for intensive care, albumin infusion, hyperalimentation, APACHE II score, serum albumin concentration, days in intensive care and prognosis within three months were analyzed. Results. Univariate statistical analysis showed that the serum albumin concentration and APACHE D score correlated well with patient survival (p = 0.002 andp = 0.025, respectively). Multivariate analysis showed that hypoalbuminemia was independently associated with patient outcome (p = 0.003). Simple albumin infusion or hyperalimentation for patients with hypoalbuminemia did not improve survival. Conclusions. The results suggest that serum albumin concentration appears to be a good prognostic marker for acute surgical patients. While decreased serum albumin concentration may also reflect poor nutritional status, for patients with moderate to severe hypoalbuminemia due to other causes, simple albumin infusion and/or nutritional support did not significantly improve survival. Consequently, aggressive treatment of the underlying disease is far more important. |
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