ICU患者腹内压和腹腔灌注压影响因素分析

Study of the influencing factors on Intra-abdominal pressure and abdominal perfusion pressure in ICU patients.

目的观察ICU患者腹内压和腹腔灌注压的变化,分析二者的影响因素。方法用膀胱测压法监测40例ICU患者的腹内压和腹腔灌注压,分析体位、肌松、腹水、体质指数、病情严重程度、镇静、PEEP水平、液体潴留等因素对患者腹内压和腹腔灌注压的影响。结果患者平卧位时的平均腹内压为(12±5) mm Hg,明显低于30°半卧位时的平均腹内压(15±6)mm Hg和俯卧位时的平均腹内压(16±4)mm Hg(均P<0.01);有腹水患者的平均腹内压明显高于无腹水患者(P<0.05);使用肌松剂患者的平均腹内压明显低于未使用肌松剂患者(P<0.01);ODIN评分、Ramsay评分、PEEP水平、液体出入量差值与患者的腹内压变化无关,体质指数与患者的腹内压变化有关(r^2=0.13,P<0.01),ODIN评分与患者的腹腔灌注压变化存在负相关(r^2=0.08,P<0.01)。结论ICU患者的腹内压存在明显个体差异;体位、肌松、腹水、体质指数等因素会影响患者的腹内压,监测腹腔灌注压能更好地判断腹腔间隔室综合征患者的预后。

Objective To study the influencing factors on intra- abdominal pressure （IAP） and abdominal perfusion pressure （APP） in ICU patients, in order to accurately know the changes of intra - abdominal pressure and abdominal perfusion pressure. Methods The IAPs and APPs of the ICU patients were measured through monitoring the bladder pressures. The impact of body position, curarization, ascites, body mass index （ BMI ）, severity of the disorders, sedation,PEEP level and fluid retention on IAP and APP were analyzed,respectively. Results Mean IAP of patients at supine position was （12 ± 5 ）mm Hg, significantly lower than which at 30° semi -recumbent position （15 ± 6 mm Hg, P 〈 0.01 ） and at prone position （ 16 ± 4 mm Hg, P 〈 0.01 ）. The mean IAP was significantly higher in patients with ascites than in patients without ascites （P 〈 0.05 ）. The mean IAP was significantly lower in patients using muscle relaxants（P 〈0.01 ）. There was no correlation between the changes of IAP and ODIN score, Ramsay score, PEEP level ,difference between input and output fluid amount ,a positive correction between BMI and IAP changes（r^2 =0.13 ,P 〈 0.01 ） and a negative correlation between ODIN score with APP changes（ r^2 = 0.08 ,P 〈 0.01 ）. Conclusion Significant individual differences occur on IAP. IAPs of ICU patients could be affected by body position, curarization, ascites and BMI. The use of muscle relaxants in patients could reduce IAP. If the abdominal compartment syndrome exists, monitoring abdominal perfusion pressure could predict the prognosis of the patients more accurately.