脓毒性休克大量晶体液复苏与腹腔间隔室综合征的关系

Relationship between high-dose crystalloid fluid resuscitation and abdominal compartment syndrome in patients with septic shock： analysis of 50 cases

目的探讨脓毒性休克患者大量输注晶体液与并发腹腔间隔室综合征（ACS）的关系。方法50例脓毒性休克患者，男36例，女14例；平均年龄（48．20±13．62）岁，接受晶体液输注，发病48h内晶体液入量〉15L组19例，〈15L组31例。50例中13例并发腹腔高压（IAH）但没有达到腹腔问隔室综合征（ACS）的标准，8例并发ACS，余29例作为对照组。分析休克后48h内晶体液输入量与IAH（包含ACS）发病率的关系。结果休克后48h内晶体液输入量ACS组为（11．77±3．68）L，显著高于IAH组[（8．25±2．43）L，t=2．68，P〈0．05]和对照[（5．59±2．71）L，t=-2．75，P〈0．05]。而IAH组的48h内品体液输入量亦显著高于对照组（t=2．62，P〈0．05）。晶体液入量〉15L组的IAH（包含ACS）发病率为68．42％（13／19），显著高于晶体液入量〈15L组（25．81％，8／31，P〈0．05）。结论大量晶体液的输入与脓毒性休克患者并发LAH与ACS呈正相关。

Objective To investigate the relationship between high-dose crystalloid fluid infusion and abdominal compartment syndrome （ACS） in patients with septic shock Methods Fifty patients with septic shock, 36 males and 14 females, aged （48.20± 13.62）, underwent crystalloid fluid resuscitation, 19 of them received crystalloid fluid of the dose 〉15 L and 31 of them received crystalloid fluid of the dose 〈 15 L within 48 hours. Eight patients developed ACS and 13 of the 50 patients developed intra-abdominal hypertension （IAH） only. The remaining 29 patients were used as controls. The relationship between high-dose erystalloid fluid infusion and ACS was analyzed. Results The amount of infused erystalloid fluid within 48 hours after shock of the ACS group was （11.77±3.68） L, significantly higher than that of the IAH group [（8.25±2.43） L, t=2.68, P 〈0.05] and that of the control group [（5.59±2.71 ） L,t=-2.75, P 〈0.05]. And the amount of infused crystalloid fluid of the IAH group was significantly higher than that of the control group too （t=2.62, P〈0.05）. The incidence of IAH and ACS of the crystalloid fluid 〉15 L group was 68.42% （13/19）, significantly higher than that of the crystalloid fluid 〈15 L group（25.81%, 8/31, P〈0.05）. Conclusion Large crystalloid fluid infusion is positively correlated with the incidence of ACS after septic shock.