术前前白蛋白对心脏手术结局的影响

　　背景：心脏手术患者术前营养不良日益普遍。虽然前白蛋白是一项应用普遍的营养状态指标，但在心脏手术患者术前评估应用尚未很好定义。本研究旨在明确术前前白蛋白对心脏手术结局的影响。

　　资料与方法：前瞻性收集了2013年2月到2013年7月69例心脏手术的患者的资料。在术前24h内检测了前白蛋白水平。根据前白蛋白的界值20mg/dL将患者分为两组。

　　结果：在69例患者中，32（46.4%）患者的术前前白蛋白≤20mg/dL。前白蛋白水平与体重指数之间无相关性（r=−0.13，P=0.28）。同样地，术前白蛋白与前白蛋白之间也无相关性（r=0.09，P=0.44）。与5.4%术前高前白蛋白患者相比，28.1%的术前低前白蛋白患者发生了术后感染（P=0.010）。术前低前白蛋白患者术后插管＞12h的风险也增加（P=0.010）。

　　结论：术前前白蛋白≤20mg/dL的心脏手术患者术后感染和机械通气时间延长风险增加。如果可行，应考虑在心脏手术之前对此类患者进行营养改善。

JPEN J Parenter Enteral Nutr. 2015;39(7):870-4.

Impact of Preoperative Prealbumin on Outcomes After Cardiac Surgery.

Yu PJ, Cassiere HA, Dellis SL, Manetta F, Kohn N, Hartman AR.

North Shore University Hospital, Manhasset, New York.

The Feinstein Institute for Medical Research, Manhasset, New York.

BACKGROUND: Preoperative malnutrition is increasingly prevalent in patients undergoing cardiac surgery. Although prealbumin is a widely used indicator of nutrition status, its use in the preoperative assessment of patients undergoing cardiac surgery is not well defined. The purpose of this study is to determine the impact of preoperative prealbumin levels on outcomes after cardiac surgery.

MATERIALS AND METHODS: Data were prospectively gathered from February 2013 to July 2013 on 69 patients undergoing cardiac surgery. Prealbumin levels were obtained within 24 hours of surgery. Patients were divided into 2 groups based on a prealbumin cutoff value of 20 mg/dL.

RESULTS: Of the 69 patients, 32 (46.4%) had a preoperative prealbumin ≤ 20 mg/dL. There was no correlation between prealbumin levels and body mass index (r = -0.13, P = .28). Likewise, there was no correlation between preoperative albumin and prealbumin levels (r = 0.09, P = .44). Nine of 32 (28.1%) patients with low preoperative prealbumin levels had postoperative infections compared with 2 of 37 (5.4%) patients with high prealbumin levels (P = .010). Patients with low prealbumin levels also had increased risk of postoperative intubation for > 12 hours (P = .010).

CONCLUSIONS: Patients undergoing cardiac surgery with preoperative prealbumin levels of ≤ 20 mg/dL have an increased risk for postoperative infections and the need for longer mechanical ventilation. If feasible, nutrition optimization of such patients may be considered prior to cardiac surgery.

KEYWORDS: cardiac disease; enteral nutrition; nutrition; nutrition assessment; research and diseases

PMID: 24898210

DOI: 10.1177/0148607114536735