腹腔压力与重症急性胰腺炎严重程度的关系

Relationship between intra-abdominal pressure and severity in patients with severe acute pancreatitis

目的重症急性胰腺炎（severe acute panereatitis，SAP）是腹腔内压（intra-abdominal pressure，IAP）升高的主要原因之一。本研究进一步探讨IAP与SAP严重程度和预后的关系。方法收集2000年1月至2008年1月期间收治于首都医科大学宣武医院普外ICU的重症急性胰腺炎患者75例（增强CI、诊断急性胰腺炎，并且至少有一个器官功能障碍），回顾性分析其中监测IAP的患者56例，根据IAP的大小分为3组，分别为A组（7～15mmHg）、B组（16—25mmHg）、C组（26～31nm mmHg），比较各组最大APACHEⅡ评分、Ranson评分、C-反应蛋白（C—responseprotein，CRP）、动脉血乳酸、肌酐、脏器功能不全发生率、住院时间和死亡率。结果56例SAP患者中，男性24例，女性32例，年龄（21～72）岁，（52±14．1）岁，体质量指数21～35，（28±12．5）。其中胆石性胰腺炎27例，酒精性14例，高脂血症性11例，其他病因不明4例。56例患者腹腔高压的发生率为89％（50／56），32％（1s／56）患者并发腹腔室隔综合征。A，B，C组分别有患者22，26，8例，随着IAP的增高，最大APACHEⅡ、Ranson评分、CRP、动脉血乳酸、肌酐、脏器功能障碍、死亡率均显著上升，死亡率分别为13．6％（3／22），23．1％（6／26），62．5％（5／8）（70=7．56，P=0．023），总体住院死亡率25％（14／56），3组住院时间差异无统计学意义（F=2．23，P=0．117）。结论腹腔压力是SAP严重程度的标志之一，IAP的监测有助于SAP预后的判断。

Objective Previous investigations suggest that severe acute pancreatitis （SAP） is one of the main causes of intra-abdominal pressure （lAP） increase. The aims of this study were to evaluate the increased lAP in patients with SAP and the con＇elation between IAP and severity or prognosis. Method Data of 75 SAP patients admitted to Xuan-Wu Hospital of Capital Medical University intensive care unit with SAP from January 2000 to January 2008 were collected. All the patients had at least one organ dysfunction, and they were diagnozed with enhanced CT, IAP were monitored in the 56 patients. The 56 patients were divided into three groups according to lAP, group A （7- 15 mmHg）, group B （16- 25 mmHg） and group C （26- 31 mmHg）. Maximal APECHE Ⅱ score, maximal Ranson score, maximal C-response protein （CRP）, maximal arterial lactate, maximal creatinine, organ dysfunction, length of stay and mortality were compared. Results The 56 patients （24 male and 32 female） with average age of （52 ±14.1 ） years （ ranging 21 - 72 years） and average body mass index （BMI） of 28 ± 12.5 （ranging 21 - 35） were monitored with IAP. The etiologic causes of SAP were biliary in 27 patients, alcohol in 14 cases, hyperlipidemia in 11 cases and idiopathic in 4 cases. The rate of intra-abdominal hypertension was 89% （50/56）, and 32% （18/56） patients complicated with abdominal compartment syndrome. There were 22, 26 and 8 patients in the A, B and C groups respectively. With the increasing of IAP, the maximal APACHE Ⅱ , maximal Ranson score, maximal CRP, maximal creatinine, organ dysfunction and mortality were also increased significantly. The mortality of the three groups was 13.6 % （3/22）, 23.1% （6/26） and 62.5 % （5/8） respectively （x^2 =7.56, P = 0. 023）, and the total mortality of the 56 patients was 25 %. The hospital stay of the three groups had no significant difference （ F = 2.23, P = 0.117）. Conclusions IAP may be one of the markers used to evaluate the severity of SAP, and the monitoring of IAP is useful to assess the prognosis in patients with SAP.