腹部大手术后液体平衡及SIRS与腹腔内压力变化的关系

The relation of fluid balance on intra-abdominal pressure after major abdominal surgery

目的:探讨腹部大手术后腹腔内高压(IAH)的发生率,评估腹腔内压力(IAP)变化与液体平衡及全身性炎症反应综合征(SIRS)的关系。方法:以本院腹部大手术后入IUC监护的57例患者为研究对象,通过膀胱内测压法测量术后连续3天的IAP值、IAP日变化值并记录24h液体平衡,根据ACCP/SCMM的SIRS标准将研究对象分为SIRS组和Non-SIRS组,记录术后3天内每组IAH和Non-IAH患者例数及IAP值。结果:57例患者中术后发生IAH者占32.8%,24h液体平衡与IAP变化呈正关(r1=0.554,r2=0.522,r3=0.571,P<0.01);SIRS组IAH发生例数多于Non-SIRS组,并且IAP值高于Non-SIRS组(P<0.01)。结论:IAH多发生在腹部大手术后,24h液体平衡以及SIRS是发生IAH的危险因素。

Objective：The objectives of this study were to determine the incidence of intra-abdominal hypertension in patients after major abdominal surgery and to evaluate the correlation of intra-abdominal pressure with fluid balance and systemic inflammatory response syndrome.Methods：57 patients,admitted to ICU of our hospital after major abdominal surgery,were included into the study.Through measurement of bladder pressure measured the IAP value,IAP changes in value and record the 24 h day fluid balance of the 3 consecutive days,according to ACCP/SCMM of SIRS standard subjects were divided into SIRS group and the Non-SIRS group,recorded after 3 days not only the number of IAH and Non-IAH patients but also the IAP values.Results：57 patients were included into the study.Intra-abdominal hypertension was diagnosed in about 32.8% of the patients in the early postoperative period.The study showed a significant positive correlation between 24-hour fluid balance and daily changes in intra-abdominal pressure（r1=0.554,r2=0.522,r3=0.571,P0.01）.A significant association was also seen between the number of positive systemic inflammatory response syndrome criteria and intra-abdominal pressure,and intra-abdominal pressure was significantly higher in patients with systemic inflammatory response syndrome（P0.01）.Conclusions：Intra-abdominal hypertension occured commonly in patients after major abdominal surgery,and patients with positive 24-hour fluid balance and/or systemic inflammatory response syndrome were at risk of having higher intra-abdominal hypertension.