Günel E, Cağlayan O, Cağlayan F, Sahin T K
Departments of Pediatric Surgery, Biochemistry and Public Health, Selçuk University, School of Medicine, Konya, Turkey.
Pediatr Surg Int. 1998 Dec;14(3):199-201. doi: 10.1007/s003830050486.
The metabolic response to surgical stress is a nonspecific increase in hepatic synthesis of some specialized acute-phase proteins and a decrease in plasma concentrations of visceral proteins following surgical trauma. This study was undertaken determine which specific proteins were the better clinical indices in monitoring the metabolic response to surgical stress in children recovering from minor surgery. Forty-four patients undergoing elective inguinal surgical procedures under general anesthesia were studied. Blood samples were collected preoperatively (-1) and at 1(+1) and 5(+5) days postoperatively to determine albumin (AL), Prealbumin (PA), C-reactive protein (CRP), and a1-acid glycoprotein (AGP) values, and to calculate the prognostic inflammatory and nutritional index (PINI). Mean AL values were the same on all days. Mean PA +1 was significantly lower than PA -1 and PA +5 (P < 0.001). Median CRP +1 and mean AGP +1 values were significantly higher than median CRP -1 and mean AGP -1 (P < 0.0001), respectively. Although there was a decrease after postoperative day 1, median CRP +5 and mean AGP +5 values were still significantly higher than preoperative values (P < 0.01 and P < 0.0001). Moreover, the median PINI +1 was also greater than PINI -1 and PINI +5 (P < 0.0001), but the median PINI+5 was significantly higher than PINI -1 (P < 0.01). Median percent changes of PINI values were significantly higher than those of the other parameters from both preoperatively to postoperative day 1 and preoperatively to postoperative day 5. Although several specific proteins (AL, PA, CRP, and AGP) have been evaluated as indicators of the acute metabolic response, we suggest that the PINI is more valuable for reflecting the response to surgical stress in patients recovering from minor surgery.
手术应激的代谢反应是手术创伤后肝脏合成某些特定急性期蛋白非特异性增加，以及血浆中内脏蛋白浓度降低。本研究旨在确定哪些特定蛋白是监测小儿小手术后手术应激代谢反应的更好临床指标。对44例在全身麻醉下接受择期腹股沟手术的患者进行了研究。术前（-1）、术后1天（+1）和5天（+5）采集血样，以测定白蛋白（AL）、前白蛋白（PA）、C反应蛋白（CRP）和α1-酸性糖蛋白（AGP）值，并计算预后炎症和营养指数（PINI）。所有时间点的平均AL值相同。术后1天的平均PA显著低于术前和术后5天（P<0.001）。术后1天的CRP中位数和AGP平均值分别显著高于术前（P<0.0001）。虽然术后第1天之后有所下降，但术后5天的CRP中位数和AGP平均值仍显著高于术前值（P<0.01和P<0.0001）。此外，术后1天的PINI中位数也高于术前和术后5天（P<0.0001），但术后5天的PINI中位数显著高于术前（P<0.01）。从术前到术后1天以及术前到术后5天，PINI值的中位数变化百分比显著高于其他参数。虽然已评估了几种特定蛋白（AL、PA、CRP和AGP）作为急性代谢反应的指标，但我们认为PINI在反映小手术后恢复患者的手术应激反应方面更有价值。
