腹腔内灌注压对重症急性胰腺炎患者预后的影响

Effect of abdominal perfusion pressure on prognosis of patients with severe acute pancreatitis

目的了解腹腔内灌注压变化对重症急性胰腺炎患者预后的影响,并比较腹内压、腹腔灌注压及APACHE-Ⅱ评分对重症急性胰腺炎患者死亡率的评价作用。方法选取2007年12月-2009年6月入住我院急诊重症监护室的36例重症急性胰腺炎(SAP)患者,每日监测腹内压(IAP),计算腹腔内灌注压(APP)并记录临床数据进行APACHE-Ⅱ评分。结果36例患者中23例(64%)存在腹内高压(IAH),IAH患者具有更高的院内死亡率(56.5%),APP<7.98kPa的患者死亡率高于APP≥7.98kPa的患者(90.9%vs12%,P<0.01)。IAP与APACHE-Ⅱ评分存在正相关(r=0.938,P<0.01),而APP与IAP及APACHE-Ⅱ评分存在明显负相关(r=-0.972,-0.906,P<0.01)。通过受试者工作特征曲线比较,APP指标ROC曲线下面积最大(94.5%)。结论SAP患者入院时存在IAH或APP<7.98kPa死亡率明显增高。APP作为独立指标对SAP患者预后的评价优于APACHE-Ⅱ评分及IAP。

Objective To observe the effects of abdominal perfusion pressure（APP） on the prognosis of patients with severe acute pancreatitis（SAP） and compare the effects of intra-abdominal pressure（IAP）,APACHEⅡ-score and APP on the mortality rate of SAP patients.Methods Thirty-six SAP patients,admitted to the ICU of Emergency Department in our hospital from December 2007 to August 2009,were enrolled in this study.Their IAP and APP were measured daily and scored with APACHE-Ⅱ.Results Of the 36 patients,23（64%）developed a high IAP on admission and their mortality rate was 56.5%.The mortality rate of those with their APP7.98kPa was higher than that of those with their APP≥7.98kPa（90.9% vs 12%,P0.01）.APP was positively correlated with APACHE-Ⅱscore（r=0.938,P0.01） and negatively correlated with IAP and APACHE-Ⅱscore（r=-0.972 and-0.906,P0.01）.The largest area was observed under the curve of APP（94.5%）.Conclusion The mortality rate of SAP patients with a high IAH or an APP7.98kPa on admission is rather high.APP,as an independent index of prognosis of SAP patients,is advantageous over APACHE-Ⅱ score and IAP.