腹腔内压监测在重症急性胰腺炎患者中的应用

Application of intra-abdominal pressure monitoring in patients with severe acute pancreatitis

目的：探讨腹腔内压（ IAP ）监测在重症急性胰腺炎患者监测和治疗中的临床价值。方法对ICU 82例重症急性胰腺炎患者动态监测腹腔内压力变化，分析腹腔内压升高对呼呼吸功能、血流动力学及肾功能等方面变化的影响，并行早期干预。结果常规监测82例重症急性胰腺炎患者中，首次测量腹腔内压前后患者心率、血压、末梢血氧饱和度、呼吸等改变差异无统计学意义（ P＞0．05）；54例腹内压升高患者，干预前 CVP、HR、氧合指数、MAP、IAP 分别为（17±177;5） cmH2 O，（132±177;18）次／min，（240±177;60），（45±177;12）mmHg，（22±177;8）mmHg，干预后分别为（13±177;4）cmH2O，（118±177;12）次／min，（320±177;80），（65±177;8）mmHg，（12±177;6）mmHg，干预前后比较差异有统计学意义（t值分别4．59，5．58，5．88，10．19，7．35；P＜0．01）。结论腹腔内压升高与重症急性胰腺炎患者的病情与预后有密切关系，对重症急性胰腺炎进行常规腹腔内压监测有助于对病情的评估和预后的判断，采取及时有效的治疗与护理，可以预防腹腔间隔室综合征的发生与发展，而且可协助判断重症胰腺炎的手术时机。

Objective To explore the clinical value of monitoring intra-abdominal pressure （ IAP） in the monitoring and treatment of patients with severe acute pancreatitis .Methods The changes of IAP in 82 patients with severe acute pancreatitis in the intensive care unit were dynamically monitored , and the effects of the increased IAP on respiratory , hemodynamic , kidney function and so on were analyzed , and the early intervention was carried out .Results No differences were found in the changes of heart rate , blood pressure , peripheral blood oxygen saturation , respiratory before and after the first measurements of IAP in 82 patients（P＆gt;0.05）.The CVR, HR, oxygenation index, MAP and IAP in 54 patients with increased IAP were respectively （17 ±177;5） cmH2O, （132 ±177;18） beats/min, （240 ±177;60）, （45 ±177;12） mmHg and （22 ±177;8） mmHg before the intervention, and were （13 ±177;4） cmH2O, （118 ±177;12） beats/min, （320 ±177;80）, （65 ±177;8） mmHg and （12 ±177; 6） mmHg after the intervention, and the differences were statistically significant （ t =4.59, 5.58, 5.88, 10.19, 7.35, respectively;P＆lt;0.01）.Conclusions The increased IAP correlates closely with the condition and prognosis of patients with severe acute pancreatitis .The routine IAP monitoring for patients with severe acute pancreatitis is helpful to the evaluation of condition and prognosis , and is also helpful to take timely and effective treatment and nursing , and can prevent the occurrence and development of abdominal compartment syndrome and assist the judgment of operation time for severe acute pancreatitis .