ICU内腹内压升高的危险因素及对预后影响的临床观察

Clinical observation of risk factors of intra-abdominal hypertension in ICU and its effect on the outcome

目的探讨重症监护室(ICU)内腹内压升高的危险因素及对预后的影响。方法应用膀胱测压法选择105例腹腔内高压(IAH)住院患者。记录每例患者的年龄、性别、人体质量指数、入住ICU至发生IAH时间、APACHEⅡ评分、SOFA评分、腹部手术史和并发症的情况。同时记录每天所测得的腹内压平均值、Glasgow评分、氧合指数、平均动脉压、血管活性药物的使用及24h尿量。取住院期间腹内压最高值及当天所测各项指标最差值进行比较。结果腹内压升高与患者的人体质量指数、APACHEⅡ评分、SOFA评分、腹部手术史和存在并发症相关,并且随着腹内压的升高,对神经、呼吸、心血管、肾脏系统的影响越严重(P<0.05)。结论应对ICU内高危人群常规进行腹内压监测,以早期预防并发症的发生。

Objective To investigate the risk factors of intra - abdominal hypertension （ IAH ） and its effect on the outcome. Methods The IAHs of 105 in - patients were determined by monitoring the bladder pressures. Their age, gender, body mass index （ BMI） , time from admitting into ICU to incidence of IAH, APACHE Ⅱ score, SOFA score, history of abdominal operation and complications were recorded. At the same time, the mean value of IAH everyday, Glasgow score, oxygenation index, mean arterial pressure, the usage of cathecholamine and urine volume in 24 hours were recorded. The maximum value of IAH and the poorest value of above - mentioned indexes at that time were compared. Results IAH correlated with BMI, APACHEⅡ score, SOFA score, history of operation and complications. The influence of nerves system, respiratory system, cardiovascular system, renal system is worse with the elevation of intra - abdominal pressure （ P 〈 0. 05）. Conclusion We should monitor the intra - abdominal pressure of high risk group in order to prevent the occurrence of complications at the early stage.