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目的:评价围手术期血液前白蛋白水平(PA)及白细胞计数(WBC)对胃肠癌患者术后发生手术部位感染(surgical site infection,SSI)的预测价值。方法 :回顾性收集2014年至2015年行手术治疗的110例胃肠癌患者临床资料,根据术后是否发生SSI将其分为感染组和对照组,比较两组患者术前及术后第1、3、5天血清PA和WBC的变化,并分析其与术后SSI之间的关系。结果:20例患者术后出现SSI,其中切口感染18例,器官/腔隙感染2例;术后发现并作出SSI诊断的时间为(6.3±1.5)d。感染组与对照组间术前PA及WBC水平无统计学差异(P>0.05);术后第3天PA及WBC在感染组与对照组患者中均出现峰值/谷值,且两组间存在显著差异(P<0.05);术后第5天对照组患者PA及WBC基本恢复至术前水平,而感染组患者恢复延迟,但两组患者无统计学差异(P>0.05);ROC曲线分析显示,术前PA与术后第3天PA的差值(ΔPA)比术后第3天PA、WBC预测术后SSI的价值更为显著。多元回归分析显示,ΔPA>87 mg/L是术后发生SSI的独立因素。结论:血清PA可作为早期预测胃肠癌术后患者发生SSI的敏感指标,进而实现临床的早期干预。
Objective: To evaluate the predictive value of perioperative prealbumin (PA) and white blood cell count (WBC) in patients with gastrointestinal cancer after surgical site infection (SSI). Methods: The clinical data of 110 patients with gastrointestinal cancer underwent surgical treatment from 2014 to 2015 were retrospectively collected. According to whether SSI occurred after operation, the patients were divided into infection group and control group. The patients in the two groups were compared before and after operation , 3,5-day serum PA and WBC changes, and analyze the relationship between postoperative SSI. Results: SSI was observed in 20 patients, including 18 cases of incision infection and 2 cases of organ / lacunar infection. The time to diagnosis and SSI diagnosis was (6.3 ± 1.5) days after operation. There was no significant difference in the preoperative PA and WBC levels between the infected group and the control group (P> 0.05). On the 3rd postoperative day, PA and WBC peaked / trough in both infected and control groups (P <0.05). PA and WBC in control group recovered to preoperative level on the fifth day after operation, while patients in infected group recovered delay, but there was no significant difference between the two groups (P> 0.05). ROC curve analysis The difference between preoperative PA and postoperative PA on day 3 (ΔPA) was more significant than that predicted by PA and WBC postoperatively on the third postoperative day. Multivariate regression analysis showed that ΔPA> 87 mg / L was an independent factor for postoperative SSI. Conclusions: Serum PA can be used as a sensitive index for early prediction of SSI in postoperative patients with gastrointestinal cancer, and then achieve early clinical intervention.