液体复苏对危重患者腹腔高压的影响

The Impact of Fluid Resuscitation on Intra-abdominal Hypertension in Critically Ill Patients

目的探讨液体复苏对危重患者腹腔高压（intra—abdominal hypertension，IAH）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，比较IAH组和非IAH组的每日液体平衡量及累积液体平衡总量。IAH组和非IAH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、住院存活例数均无显著差异。结果与非IAH组比较，IAH组住院第1、2、4天液体平衡量显著增加[中位数2780（690—5390）ml vs．2134（-275—5600）ml，Z=-3．107，P=0．002；1415（1000～3060）ml VS．890（-1200～3300）ml，Z=-4．045，P=0．000；350（～1250～2320）ml VS．180（-1250～1230）ml，Z=-2．189，P=0．029]，2组在第3、5天液体平衡量无显著差异；IAH组的1～5日每日累积液体平衡量均显著增加[中位数2780（690～5390）mlVS．2134（-275—5600）ml，Z=-3．107，P=0．002；（4490±1149）ml VS．（3240±1724）ml，t=3．277，P=0．002；（5393±1490）mlVS．（4147±1916）ml，t=2．869，P=0．005；（5830±1913）mlVS．（4136±2176）ml，t=3．350，P=0．001；（5791±2533）mlVS．（4440±2411）ml，t=2．377，P=0．022]。结论大量液体复苏与IAH有关，对危重患者进行液体复苏的同时，早期监测危重患者腹内压，有利于早期发现IAH及腹腔间隔室综合征。

Objective To investigate the impact of fluid resuscitation on intra-abdominal hypertension （IAH） in critically ill patients. Methods Intra-abdominal pressure （IAP） was measured through the bladder technique in critically ill patients from March 2010 to August 2010. Daily fluid balance and cumulative fluid balance were compared between the IAH group and the non-IAH group. There were no significant differences in sex, age, acute physiology and chronic health evaluation II （ APACHE II ） score, sequential organ failure assessment （SOFA） score, lengths of mechanical ventilation and ICU stay, and survival before discharge between IAH group and non-IAH group. Results There was significant daily fluid balance increase on the 1st , 2nd, 4th day after admission in IAH group compared with that of the non-IAH group [median, 2780 （690 -5390） ml vs. 2134 （ -275 -5600） ml, Z = -3. 107, P=0.002; 1415 （1000-3060） ml vs. 890 （ - 1200 -3300） ml, Z = -4.045, P =0.000; 350 （ - 1250-2320） ml vs. 180 （ -1250- 1230） ml, Z = -2. 189, P = 0. 029 ]; there was no significant difference in daily fluid balance on the 3th , 5th day after admission between IAH group and non-IAH group; there was increasingly higher daily cumulative fluid balance in the IAH group from the 1st to the 5th day after admission than the non-IAH group[ median 2780 （690 -5390） ml vs. 2134 （ -275 -5600） ml, Z = -3. 107, P=0.002; （4490±1149） mlvs. （3240±1724） ml, t=3.277, P=0.002; （5393±1490） mlvs. （4147±1916） ml, t=2.869, P=0.005; （5830±1913） mlvs. （4136 ±2176） ml, t=3.350, P=0.001; （5791±2533）mlvs. （4440 ±2411） ml, t = 2. 377, P = 0. 022 ]. Conclusions Excessive fluid resuscitation was associated with IAH. Earlier lAP measurements for patients requiring fluid resuscitation are essential for the detection of IAH and abdominal compartment syndrome （ACS）.