妊娠末期急性胰腺炎腹腔压力与母胎预后临床分析

Relationship between intraabdominal pressure and maternal - fetal prognosis in acute pancreatitis during the third trimester of pregnancy

目的 探讨妊娠末期并发急性胰腺炎（AP）时腹腔压力（IAP）与母胎预后的关系.方法 回顾性研究2005-01 ～2009-12我院普通外科收治妊娠末期并发急性胰腺炎患者9例.轻型急性胰腺炎患者2例,胎儿均存活 重型急性胰腺炎患者7例,其中胎儿发生宫内窘迫但存活3例,因家属放弃而引产死胎1例,死产1例,胎儿宫内死亡2例.结果 轻型胰腺炎患者均未发生腹腔高压,重型急性胰腺炎患者均合并腹腔高压,其中腹腔间室综合征1例.无并发症的患者与发生并发症患者的腹腔内压力比较差异有统计学意义.发生胎儿宫内异常的患者与未发生宫内胎儿异常的患者腹腔内压力比较,差异有统计学意义（P〈0.05）.获得健康存活新生儿的患者与死胎/死产患者的腹腔内压力比较,差异无统计学意义（P〉0.05）.结论 妊娠末期并发急性胰腺炎时,随着腹腔压力的增高,母体并发症增多而且程度加重,胎儿宫内异常发生率增加.对于妊娠末期并发急性胰腺炎患者应该连续监测腹腔压力,积极减压治疗,缩短腹腔高压持续时间 必要时终止妊娠治疗,以获得最佳母婴预后.

Objective To evaluate the relationship between intraabdominal pressure and maternalfetal prognosis in acute pancreatitis during the third trimester of pregnancy. Methods Medical records were reviewed retrospectively for every pregnant woman complicated with acute pancreatitis during the third trimester consecutively who was admitted to our department from January 2005 to December 2009. There were 2 mild acute pancreatitis cases and 7 severe acute pancreatitis patients. Results The intraabdominal pressure was no more than 12 mm Hg in the cases with mild acute pancreatitls. Seven pregnant women complicated with severe acute pancrealitis had intraahdominal hypertension, and one woman had abdominal compartment syndrome simultaneously. The intraabdominal pressure in patients without complications was significant lower than that in cases with complications [ 8.8 mm Hg vs （15.5 ±3.2 ）mm Hg, P = 0.001 ]. Patients with abnormal fetus had higher intraabdominal pressure than patients with normal intrauterine fetus[ （ 16.1± 3. 1 ） mm Hg vs（ 10.3±2. 1 ） mm Hg, P =0. 047 ）]. Conclusion Maternal -fetal prognosis was worse with the higher intraabdominal pressure. The intraabdominal pressure should be monitored continuously and the duration of intraabdominal hypertension should be shortened once the pregnant women complicated with acute pancreatitis during the third trimester. In order to improve the maternal - fetal outcome, termination of pregnancy is beneficial.