腹腔内高压对危重患者器官功能的影响

The Effect of Intra-abdominal Hypertension on the Organ Function of Critically Ill Patients

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.