腹腔高压对重症急性胰腺炎患者呼吸功能的影响

Effect of intra - abdominal hypertension on respiration function of patients with severe acute pancreatitis

目的 评价腹高压（IAH）及腹腔间隔综合征（ACS）对重症急性胰腺炎（SAP）患者呼吸功能的影响.方法 回顾分析90例SAP住院患者的临床资料.根据患者入院时测定的腹内压值分为：腹内压〈12 mm Hg组（腹内压正常组,n=16）;腹内压≥12 mm Hg （IAH组,n=56）;腹内压≥20 mm Hg （ACS组,n=18）.收集患者入院后的临床资料和血气分析结果,比较不同水平腹内压对呼吸功能的影响.结果.90例SAP患者入院时ALI/ARDS 38例,发生率42.0%,其中腹内压正常组发生率31.3%,IAH组为44.6%,ACS组为66.7%.两两比较显示：ACS组ALI/ARDS发生率显著高于腹内压正常组患者（P〈0.05）.入院第3、7天时,ACS组ALI/ARDS发生率均明显高于腹内压正常组和IAH组（P均〈0.05）.腹内压正常组与IAH组的氧分压（PaO2）、氧合指数（PaO2/FiO2）在入院后第1、3、7 天差异均无统计学意义（P〉0.05）;ACS组PaO2、PaO2/FiO2与腹内压正常组和IAH组比较明显下降（P均〈0.05）.ACS患者中机械通气比例66.7%,与腹内压正常患者（31.3%）及IAH患者（37.5%）相比,差异有统计学意义（P均〈0.05）;IAH组机械通气的比例与腹内压正常组相比,差异无统计学意义（P〉0.05）.结论.IAH的程度对SAP患者呼吸功能产生明显影响.采用合适的方式减轻、解除ALI是治疗SAP的重要环节之一.

Objective The aim of this study was to assess the effect of intra - abdominal hypertension （IAH） and abdonimal compartment syndrome （ACS） on respiration function of patients with severe acute pancreatitis. Methods 90 patients with severe acute pancreatitis were retrospectively studied. According to intra -abdominal pressure（lAP） of patients as admitted to hospital, the patients were divided into three groups. One is normal（n = 16） ; the other is IAP≥ 12 mm Hg（IAH group, n = 56） ; and another is IAP≥20 mm Hg（ACS group, n = 18）. The clinical data were analyzed to compare the effect of different degree IAP on respiration function of patients. Results The incidence of ALl/ ARDS in ACS group was higher than that of normal groups（66.7% vs 31.3% ） at 1 d and than those of normal groups and IAH group at 3 d, 7 d after admitted to hospital（ all P 〈0.05）. The data showed that PaO2 and PaOJFiO2 in ACS group was significantly decreased than those in normal and IAH groups at 1 d, 3 d and 7 d after admitted to hospital （ all P 〈0. 05 ）. in addition, compared with the patients of normal and IAH groups, the ratio of mechanical ventilation in ACS patients was higher significantly （66. 7%vs 31.3% and 66.7% vs 37.5% respectively, all P 〈 0.05）. Conclusion The results indicate that there were remarkable effects on respiration function in response to the degree of IAH with the underlying condition of SAP. The results of this study are in favor of a decompression in patients of SAP with ACS.