微量白蛋白尿在ICU中的应用
摘要
背景：近年来毛细血管渗漏综合征(capillary leak syndrome，CLS)备受关注。微量白蛋白尿(microalbuminuria，MAU)是目前国际上最常用反映毛细血管通透性增高的临床检测指标之一。但目前有关MAU判断ICU 术后患者疾病严重程度并预测预后的研究甚少，且对HES堵塞毛细血管漏的机制，尚无全面、合理的解释。 目的：观察SICU术后患者MAU水平与APACHEⅡ评分的关系，及羟乙基淀粉130/0.4、琥珀明胶、乳酸钠林格液对SICU术后患者MAU水平与炎性因子浓度的影响。 新疆师范大学学报方法：留取100例收入SICU患者的术前及术后6h的尿液标本评价MAU 水平。所有研究对象均在术后入SICU24h后进行APACHEⅡ评分。100例收入SICU患者随机分成5组(每组20例)，术中分别给予羟乙基淀粉130/0.4 500ml或1000ml、琥珀明胶500ml或1000ml及乳酸钠林格液。分别测定患者术前及入SICU6小时MAU水平和血浆IL-6浓度。
泡花碱结果：SICU术后患者MAU水平较术前明显增高，与APACHEⅡ评分呈显著正相关(P＜0.05)。人工胶体组的MACR变化水平均较晶体组低(P均＜0.05)；而相同剂量羟乙基淀粉组和琥珀明胶组MACR虽无明显差异 朝天门火灾(P=0.630；P=0.701)，但前者的MACR均值较低。各组入SICU 6h时血浆IL-6的浓度较术前基础值都明显增高(P均＜0.05)，且三种液体组间血浆IL-6的浓度变化也具有显著性差异(P均＜0.05)，其中羟乙基淀粉组最低。
结论：SICU术后患者MAU水平与APACHEⅡ评分呈显著正相关，可以用来评价疾病严重程度并预测预后。人工胶体MACR变化水平较晶体组低，且能有效降低血浆IL-6水平，提示其具有毛细血管堵漏作用及抗炎作用，其中羟乙基淀粉130/0.4的作用优于琥珀明胶。 关键词：微量白蛋白尿，APACHEⅡ评分，SICU，人工胶体，毛细血管通透性，炎性因子
APPLICATION OF MICROALBUMINURIA IN ICU
ABSTRACT
az91d镁合金Background：In recent years, capillary leak syndrome(CLS) receives more and more attention. Microalbuminuria(MAU) is one of the most commonly used clinical indexes testing the rise of capillary permeability world wide. However, there is limited research on microalbuminuria evaluating severity of illness and predicting prognosis in postoperative patients admitted to an intensive care unit, as well as a reasonable explanation of the mechanism of hydroxyethyl starch reducing capillary permeability.
天津路网Objective：To investigate the relationship between microalbuminuria and APACHEⅡ score and the effect of hydroxyethyl starch 130/0.4，gelatin and Ringer lactate solution on the level of microalbuminuria and inflammatory factors in postoperative patients admitted to a surgical intensive care unit.
Methods：Urine collection before operation and 6 hours after admission to an intensive care unit for assessment of microalbuminuria in 100 postoperative patients. APACHEⅡ score was calculated from data collected during the 24 hrs after SICU
中医美容学admission. 100 postoperative patients were randomized into five groups(n=20). They were given hydroxyethyl starch 130/0.4 500ml or 1000ml, gelatin 500ml or 1000ml and Ringer lactate solution, respectively. Microalbuminuria and the concentration of plasma IL-6 of all patients was tested before operation and 6 hours after admission to SICU.
Results：The postoperative level of microalbuminuria was remarkably higher than preoperative. MAU had a positive correlation with APACHEⅡ score(P＜0.05). MACR in both hydroxyethyl starch groups and gelatin groups were lower than crystal group(P＜0.05). However, within the same dosage, there was no significant difference of MACR between hydroxyethyl starch groups and gelati
n groups(P=0.630；P=0.701), but the means of MACR in hydroxyethyl starch groups were lower than those of gelatin groups. The plasma IL-6 level increased in every group 6 hours after admission to SICU compared to preoperative(P＜0.05). The changes of three kinds of fluid were of different levels(P＜0.05), and it seems to be the lowest in hydroxyethyl starch group.
Conclusions：Microalbuminuria has a positive correlation with APACHEⅡ score in postoperative patients admitted to a surgical
intensive care unit. It can be used to evaluate severity of illness and to predict prognosis. Hydroxyethyl starch 130/0.4 seems to be more powerful than gelatin on reducing capillary permeability, and it is predominant in anti-inflammation by reducing the level of plasma IL-6.
KEY WORDS：microalbuminuria，APACHEⅡ score，surgical intensive care unit，artificial colloids，capillary permeability，inflammatory factor
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