摘要
目的 探讨腹腔内高压(intra-abdominal hypertension,IAH)对危重患者器官功能的影响.方法 2010年3-8月,膀胱测压法监测危重患者腹腔内压,以膀胱内压≥12 mm Hg为IAH,比较IAH组和非IAH组的肾功能、呼吸功能、血流动力学等器官功能.2组性别、年龄、急性生理和慢性健康评估Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHEⅡ)评分、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、机械通气时间、住ICU时间、住院存活情况无显著差异.结果与非IAH组比较,IAH组发生多器官功能不全综合征的比例显著增加[40.0%(10/25) vs.14.3%(9/63),χ2=6.991,P=0 008],肾功能不全的比例增多[32.0%(8/25) vs.11.1%(7/63),χ2=5.523,P=0.019],急性呼吸窘迫综合征的比例、氧合指数(FiO2/PaO2)无显著差异,但气道平台压[(22.28±7.54)mm Hg vs.(13.87±3.93)mm Hg,t=6.851,P=0.000]和血管外肺水显著增加[(12.82±7.47)ml/kg vs.(7.00±2.38)ml/kg,t=2.400,P=0.032],肺顺应性显著下降[(34.20±6.98) ml/cm H2O vs.(39.16±9.82) ml/cm H2O,t=-2.302,P=0.024].与非IAH组比较,IAH组休克的比例显著增加[56.0%(14/25) vs.23.8%(15/63),χ2=7 000,P=0.008],心指数、每搏变异度、心肌收缩力和肺血管通透性指数无显著差异,胸内血容量[(766.86±99.88) ml/m2 vs.(929.18±171.56) ml/m2,t=-2.257,P=0.038]和全心舒张末容积显著降低[(613.86±79.63) ml/m2 vs.(743.36±137.30) ml/m2,t=-0.251,P=0.039].结论 IAH影响危重患者器官功能,早期监测危重患者腹内压,有利于早期发现IAH.
Objective To investigate the effect of intra-abdominal hypertension (IAH) on the organ function of critically ill patients. Methods Intra-abdominal pressure (IAP) of patients was measured through the bladder technique from March 2010 to August 2010. Patients' renal function, respiratory function, hemodynamics were compared between IAH group and non-IAH group. There was no significant difference in gender, age, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ ) score, sequential organ failure assessment (SOFA) score, length of mechanical ventilation, ICU stay, in-hospital survival between IAH group and non- IAH group. Results There was a significantly higher incidence of multiple organ dysfunction [ 40.0% ( 10/25 ) vs. 14. 3% (9/63),X^2 =6.991,P=0.008] and renal dysfunction [32.0% (8/25) vs. 11.1%(7/63),X^2 =5.523, P=0.019] in IAH group as compared to non-IAH group. There was no significant difference in the incidence of acute respiratory distress syndrome (ARDS) and FiOJPaO2 between the two groups, while patients with IAH had a significantly higher airway plateau pressure [ (22.28 ± 7.54) mm Hg vs. ( 13.87 ~ 3.93 )mm Hg, t = 6.851, P = 0. 0001 and pulmonary vascular permeability index [ ( 12.82 ± 7.47) ml/kg vs. (7.00±2.38) ml/kg, t =2.400, P=0.032], and a lower lung compliance [(34.20±6.98) ml/em H20 vs. (39.16 ±9.82) ml/em H20, t = -2. 302, P = 0. 024 ]. There was no significant difference in cardiac index, stroke volume variation, left ventricle contractility index and pulmonary vascular permeability index between the two groups. There was a significantly higher incidence of shock [ 56.0% (14/25) vs. 23.8% (15/63) , X2 = 7. 000, P = 0. 008 % , and a significantly lower intra-thoracic blood volume index [(766.86±99.88) ml/m^2 vs. (929. 18 ± 171. 56) ml/m2, t = -2.257, P =0.038] and global end-diastolic volume index [(613.86±79.63) ml/m^2 vs. (743.36±137.30) ml/m^2,t= -0.251, P=0.039] in IAH group as compared to non-IAH group. Conclusions Intra-abdominal hypertension is positively correlated with the incidence of multiple organ dysfunction. The monitoring of patients' IAP is helpful for the early diagnosis of IAH.
出处
《中国微创外科杂志》
CSCD
2013年第12期1120-1123,共4页
Chinese Journal of Minimally Invasive Surgery
基金
北京大学第三医院种子基金(2010年)
关键词
腹腔内高压
器官功能
危重患者
Intra-abdominal hypertension
Organ function
Critically ill patients