严重创伤后腹内高压与急性肾功能衰竭的关系

Relationship between intra-abdominal hypertension and acute renal failure after severe trauma

目的:探讨严重创伤后腹内高压(intra-abdominal hypertension,IAH)与急性肾功能衰竭(ARF)的关系。方法:回顾分析60例严重创伤患者的临床相关资料,确定ARF的诊断标准;采用膀胱内压检测法间接测量腹内压,伤后前3d内每天腹内压超过20mmHg者为IAH,比较IAH组与非IAH组在伤后3d的腹内压值和血清肌酐、尿素氮水平及肾小球滤过梯度、每小时尿量以及平均动脉压的变化。采用多元相关性分析严重创伤后ARF发生的相关危险因素。结果:IAH组27例患者中,12例(44.4%)发生ARF,伤后前3d肾小球滤过梯度显著降低,血清肌酐和尿素氮的水平显著升高,每小时尿量显著减少;非IAH组33例患者中,仅有3例(9.1%)发生ARF,两组比较,差异有统计学意义(P<0.05)。多元相关性分析提示,患者年龄≥60岁、伤后平均动脉压(MAP)降低、伤后IAH等与严重创伤后ARF的发生明显相关。结论:IAH是ARF发生的高度危险因素;严密监测伤后腹内压的变化,对预防与减轻ARF具有较重要的临床意义。

Objective： To investigate the relationship between intra abdominal hypertension （IAH） and acute renal failure （ARF） after severe trauma. Method： The clinical data of 60 cases of severe trauma were retrospectively analyzed. Intra abdominal pressure was indirectly measured by intravesical pressure method. On the first 3 days af-ter trauma,intra-abdominal pressure over 20 mmHg every day was regarded as IAH. Intra-abdominal pressure, ser-um creatinine and urea nitrogen levels, urine volume per hour, glomerulus filtration gradient （GFG） and mean arte-rial pressure on the first 3 days after trauma were recorded. By using bivariable correlations analysis,the periopera-tive risk factors for ARF were analyzed. Result：In IAH group （27 patients） ,GFG and urine volume per hour were significantly lower in 12 cases （44.4%）of ARF. Serum creatinine and urea nitrogen levels were significant higher than in Non-IAH group on the first 3 days after trauma. In Non-IAH group （33 patients） ,ARF occurred in on-ly 3 cases （9.1%） and the difference was significant between the two groups （P〈0.05）. Bivariable correlation a-nalysis revealed that the occurrence of ARF was significantly correlated with age （older than 60 years） ,decrease of mean arterial pressure and IAH after trauma. Conclusion： IAH impaired renal function and was an independent risk factor for ARF after severe trauma. The intra abdominal pressure is worth monitoring in those subjects.