腹腔压力监测在外科重症监护病室病情观察中的应用研究

Application study on abdomen cavity pressure monitoring for observation of patients in surgical intensive care unit

[目的 ]通过动态监测外科重症监护病室 (SICU )腹部手术后及重症病人腹腔压力变化 ,了解影响腹腔压力升高的相关因素 ,及其与血流动力学、呼吸功能及肾脏功能等方面变化的相关关系。 [方法 ]选择外科腹部手术后或腹部急性病变转入SICU病人 3 5例 ,依据经尿道膀胱内压 (UBP)测量值分为两组 ,UBP≥ 2 .45kPa为腹内高压组 ,UBP <2 .45kPa为对照组。两组均监测中心静脉压、心率、平均动脉压、呼吸频率、动脉血氧分压、二氧化碳分压、尿量及肾功能指标的变化。 [结果 ]腹内高压组中心静脉压、心率、呼吸频率、尿素氮变化与UBP改变呈显著的正相关 ,而平均动脉压与UBP呈负相关 ,与尿量改变无明显的相关性。 [结论 ]UBP改变与血流动力学、呼吸及肾功能指标有相关性。对具有腹内高压危险因素的危重病人应常规监测腹内压的变化 ,采取及时有效的治疗、护理措施 ,可以预防腹腔间隔室综合征的发生与发展。

Objective:to know about both relative factors of the increase of abdomen cavity pressure, and the correlation with hemodynamics, respiratory function and renal function by continuously monitoring abdomen pressure of postoperative patients after abdomen surgery or critical cases in surgical intensive care unit (SICU). Method: a total of 35 patients who either had had abdomen operation or with acute abdomen illness shifted into SICU, were selected and divided into test and control groups according to urethral bladder pressure (UBP) values. Patients with UBP≥2.45 kPa were in high abdominal pressure group, i.e. test group. While patients with UBP<2.45 kPa were in control group. Then the changes of central venous pressure, heart rate, mean arterial pressure,respiration rate arterial partial pressure of oxygen, partial pressure of carbon dioxide, urine volume and renal function indexes of all two group patients were monitored. Result: in test group patients, there was a significant positive correlation between the changes of UBP and the alteration of central venous pressure, heart rate,respiration rate, urea nitrogen, a negative correlation between mean arterial blood pressure and UBP, and no correlation between urine volume and UBP changes. Conclusion: it showed that the changes of UBP of patients were related to their hemodynamics, breath and renal function indexes. For those critical patients with risk factors of high intra-abdominal pressure should monitor their abdominal pressure changes as routine. To provide effective treatment and nursing care for them in time could prevent abdominal compartment syndrome from either happening or development.