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目的探讨创伤患者尿微量白蛋白(microalbuminuria,MAU)水平的早期动态改变及与创伤严重程度的关系。方法收集急诊重症病房132例创伤患者,留取创伤后第24、48、72h内的晨尿标本,采用免疫比浊法测定尿微量白蛋白,结果以尿白蛋白/肌酐比值(urinary albumin/creatinine ratio,UACR)表示。按入院后创伤严重程度评分(ISS)分为3组,即轻度创伤组(48例,ISS<16分),中度创伤组(44例,16≤ISS≤25分)和重度创伤组(40例,ISS>25分),比较3组患者不同时段的UACR水平,分析早期UACR水平与创伤严重程度的关系。结果 (1)随着创伤严重程度的增加,创伤患者的血白细胞计数、中性粒细胞比例及CRP明显增高、血浆白蛋白明显减少、住院天数显著延长(P<0.05)。(2)3组患者UACR水平在入院后24h内达到高峰,随后开始下降,中度和重度创伤组在各时段UACR水平较轻度创伤组明显升高(P<0.05)。(3)多元Logistic回归分析显示,在控制其他危险因素后,创伤后早期UACR水平是创伤严重程度的一个重要预测因子[中度创伤组:危险度(OR)=1.106;95%CI:1.055~1.159,P=0.000;重度创伤组:危险度(OR)=1.140;95%CI:1.084~1.198,P=0.000]。结论创伤患者早期UACR水平明显升高,可以作为判断创伤严重程度的早期有效指标之一。
Objective To investigate the early dynamic changes of urinary microalbuminuria (MAU) levels in traumatic patients and its relationship with the severity of trauma. Methods A total of 132 traumatic patients were collected from emergency wards. Morning urine samples were collected from the 24th, 48th and 72th hour after injury. Urine microalbuminuria was measured by immunoturbidimetry. Urinary albumin / creatinine ratio, UACR). According to the severity of injury (ISS) after admission, the patients were divided into three groups: mild trauma group (48 cases, ISS <16 points), moderate trauma group (44 cases, 16≤ISS≤25 points) and severe trauma group 40 cases, ISS> 25 points). The levels of UACR in three groups were compared at different time points to analyze the relationship between the level of early UACR and the severity of trauma. Results (1) With the increase of the severity of trauma, the number of WBC, neutrophil and CRP in patients with trauma were significantly increased, the plasma albumin was significantly decreased and the hospitalization days were significantly prolonged (P <0.05). (2) The levels of UACR in three groups peaked within 24 hours after admission, and then decreased. The levels of UACR in moderate and severe trauma group were significantly higher than those in mild trauma group at each time point (P <0.05). (3) Multivariate Logistic regression analysis showed that the level of UACR in the early post-traumatic period was an important predictor of the severity of trauma after controlling for other risk factors [moderate trauma group: hazard ratio (OR) = 1.106; 95% CI: 1.055 ~ 1.159, P = 0.000; severe trauma group: hazard ratio (OR) = 1.140; 95% CI: 1.084-1.1988; P = 0.000]. Conclusion The UACR level in early traumatic patients is obviously increased, which can be used as one of the early effective indicators to judge the severity of trauma.