利用人体成分分析仪检测围手术期患者体液含量及分布变化的临床意义

doi:10.3877/cma.j.issn.1674-0793.2018.04.003

目的

通过人体成分分析仪检测患者围手术期的体液含量及分布变化，探讨体液含量及其变化在临床中的意义及应用价值。

方法

本研究采用横断面研究方法，选择2016年3月至9月滨州医学院附属医院收治的患者123例，详细记录患者的临床资料，并进行人体成分分析检测。分析患者术前1 d与术后第1、3、5、7天细胞内液（ICW）、细胞外液（ECW）、总体液（TBW）的数据，观察术后ICW、ECW、TBW、ICW/TBW、ECW/TBW的变化。按照术后第1天ECW/TBW分组，分析患者术后第1天ECW/TBW的变化对白细胞、血红蛋白、白蛋白及临床预后的影响。

结果

患者术后早期ICW、ECW、TBW均增加，随后逐渐下降至术前水平；术后第1天ICW/TBW达到最低，ECW/TBW达到最高，随后逐渐恢复至正常。术后第1天ECW/TBW比值越高（>0.400）的患者血红蛋白及白蛋白的水平越低，术后腹腔引流管的放置时间、术后住院时间越长，术后并发症的发生率及死亡率越高。

结论

围手术期体液含量的检测对患者预后的评估、降低术后并发症具有重要的指导价值。人体成分分析仪是一种对围手术期患者的体液含量进行有效测量的工具，具有重要临床应用价值。

关键词: 体液, 体液分布, 成分分析

Objective

To explore the meaning and clinical value of detecting body fluid volume and distribution using human body composition analyzer among perioperative patients.

Methods

This study was conducted using the cross-sectional research method. A total of one hundred and twenty-three patients who underwent abdominal surgery in Binzhou Medical University Affiliated Hospital from March to August 2016 were enrolled. The volume of intracellular water (ICW), extracellular water (ECW) and total body water (TBW) was detected by Inbody S10 1 d before operation (PreD1) and 1, 3, 5, 7 postoperatively (POD 1, 3, 5, 7). Furthermore, the effects of ECW/TBW on white blood cells, hemoglobin, albumin and clinical prognosis on POD 1 were analyzed.

Results

ICW, ECW, and TBW were increased in the early stage of postoperation. On POD 1, ICW/TBW reached the lowest level, ECW/TBW reached the highest, and then gradually recovered to normal. The lower the level of hemoglobin and albumin in patients, the higher the ratio of ECW/TBW (>0.400). The longer the time of postoperative abdominal drainage and hospital stay, the higher the incidence of postoperative complications and mortality.

Conclusions

The measurement of body fluid content in the perioperative period has important guiding value for evaluating the prognosis of the patients and reducing the postoperative complications. As a reliable tool, human body composition analyzer has important clinical significance.

Key words: Body fluids, Body fluid compartments, Component analysis

表1 123例患者不同测量时间点体液指标测量结果(±s)

项目	术前	术后第1天	术后第3天	术后第5天	术后第7天
ICW(L)	19.38±3.78	19.93±3.70^a	19.57±3.57	19.45±3.73	19.21±3.43
ECW(L)	12.24±2.22	13.09±2.18^b	12.81±2.15^a	12.54±2.31	12.40±2.10
TBW(L)	31.62±5.96	33.02±5.85^b	32.39±5.67^a	31.99±5.98	31.61±5.48
ICW/TBW	0.61±0.01	0.60±0.01^a	0.60±0.01^a	0.61±0.01	0.61±0.01
ECW/TBW	0.39±0.01	0.40±0.01^a	0.40±0.01^a	0.39±0.01	0.39±0.01

表1 123例患者不同测量时间点体液指标测量结果(±s)

项目	术前	术后第1天	术后第3天	术后第5天	术后第7天
ICW(L)	19.38±3.78	19.93±3.70^a	19.57±3.57	19.45±3.73	19.21±3.43
ECW(L)	12.24±2.22	13.09±2.18^b	12.81±2.15^a	12.54±2.31	12.40±2.10
TBW(L)	31.62±5.96	33.02±5.85^b	32.39±5.67^a	31.99±5.98	31.61±5.48
ICW/TBW	0.61±0.01	0.60±0.01^a	0.60±0.01^a	0.61±0.01	0.61±0.01
ECW/TBW	0.39±0.01	0.40±0.01^a	0.40±0.01^a	0.39±0.01	0.39±0.01

图1 123例患者围手术期ECW/TBW和ICW/TBW的变化趋势　与术前相比，*P<0.05

表2 123例患者术后第1天ECW/TBW比值与患者白细胞、血红蛋白、白蛋白水平的关系(±s)

ECW/TBW	例数	白细胞计数（×10⁹/L）	血红蛋白（g/L）	白蛋白（g/L）
<0.390组	44	12.88±4.77	120.70±15.17	34.24±3.90
0.390~0.400组	47	13.26±4.31	112.45±17.31	31.58±4.33
>0.400组	32	11.90±6.40	105.91±15.45^ab	28.36±3.29^ab
F值		0.635	6.203	19.833
P值		0.375	0.000	0.000

表2 123例患者术后第1天ECW/TBW比值与患者白细胞、血红蛋白、白蛋白水平的关系(±s)

ECW/TBW	例数	白细胞计数（×10⁹/L）	血红蛋白（g/L）	白蛋白（g/L）
<0.390组	44	12.88±4.77	120.70±15.17	34.24±3.90
0.390~0.400组	47	13.26±4.31	112.45±17.31	31.58±4.33
>0.400组	32	11.90±6.40	105.91±15.45^ab	28.36±3.29^ab
F值		0.635	6.203	19.833
P值		0.375	0.000	0.000

表3 术后第1天ECW/TBW比值与患者术后结局的关系

ECW/TBW		例数	术后住院时间（d）	术后排气时间（h）	引流管放置时间（d）	并发症(例)				死亡[例(%)]
ECW/TBW		例数	术后住院时间（d）	术后排气时间（h）	引流管放置时间（d）	肺部感染	切口感染	胆瘘	肠梗阻	死亡[例(%)]
<0.390组		44	9.23±3.62	40.85±19.57	3.22±1.19	1	0	0	0	0(0)
0.390~0.400组		47	9.35±3.83	41.29±21.18	3.87±1.80	1	2	1	0	0(0)
>0.400组		32	12.85±6.52^a	49.77±18.07	5.15±3.23^a	6	6	3	1	3(9.4)
	统计值		F=6.864	F=4.830	F=4.017	χ²=30.835				χ²=8.745
	P值		0.032	0.089	0.028	0.000				0.013

表3 术后第1天ECW/TBW比值与患者术后结局的关系

ECW/TBW		例数	术后住院时间（d）	术后排气时间（h）	引流管放置时间（d）	并发症(例)				死亡[例(%)]
ECW/TBW		例数	术后住院时间（d）	术后排气时间（h）	引流管放置时间（d）	肺部感染	切口感染	胆瘘	肠梗阻	死亡[例(%)]
<0.390组		44	9.23±3.62	40.85±19.57	3.22±1.19	1	0	0	0	0(0)
0.390~0.400组		47	9.35±3.83	41.29±21.18	3.87±1.80	1	2	1	0	0(0)
>0.400组		32	12.85±6.52^a	49.77±18.07	5.15±3.23^a	6	6	3	1	3(9.4)
	统计值		F=6.864	F=4.830	F=4.017	χ²=30.835				χ²=8.745
	P值		0.032	0.089	0.028	0.000				0.013

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Clinical significance of detecting body fluid volume and distribution using human body composition analyzer among perioperative patients

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Clinical significance of detecting body fluid volume and distribution using human body composition analyzer among perioperative patients