连续性血液滤过在治疗以第三间隙液体潴留为主的腹腔高压中的应用

Continuous Blood Purification for Third-space Fluid Retention-based Intra-abdominal Hypertension

目的探讨连续性血液滤过(CBP)治疗以第三间隙液体潴留为主的腹腔高压及腹腔间隙综合征(ACS)的疗效。方法 37例诊断为以第三间隙液体潴留为主的腹腔高压或腹腔间隙综合征的患者按是否进行血液滤过分为治疗组(21例)和对照组(16例),对照组采用胃肠减压、镇痛等常规治疗,治疗组采用在常规治疗基础上给予连续性血液滤过治疗,1次·d-1,5次。记录比较治疗前后腹内压、氧合指数、平均动脉压、APACHEⅡ评分、生化指标以及TNF-α、IL-6,和C-反应蛋白(CRP)的水平。观察治疗前、治疗后患者一般情况及生化指标、炎症介质的变化,计算死亡率。结果治疗组14例腹腔高压好转,3例死亡,4例自动出院,好转率66.6%;对照组腹腔高压好转3例,死亡9例,自动出院4例,好转率18.7%。治疗组肾功能指标、乳酸、HCO-3、肌钙蛋白I(cTnI)及炎症介质CRP、TNF-α、IL-6改善明显优于对照组,病死率明显低于对照组(P<0.05)。结论 CBP可明显改善以第三间隙液体潴留为主的腹腔高压或腹腔间隙综合征的症状,降低腹内压,改善预后,降低死亡率。

Objective To evaluate the efficacy of continuous blood purification（CBP）in the treatment of the third-space fluid retention-based intra-abdominal hypertension and abdominal compartment syndrome（ACS）.Methods Thirty-seven patients diagnosed with the third-space fluid retention-based intra-abdominal hypertension or ACS were divided into two groups.The control group（n = 16）received gastrointestinal decompression,analgesia and other conventional therapies.On the basis of conventional therapies,the treatment group（n=21）was given continu-ous hemofiltration therapy once daily for at least 5 days.Intra-abdominal pressure,oxygenation index,mean arterial pressure,APACHE II score,mortality rate,biochemical index and levels of tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）and C-reactive protein（CRP）were recorded before and after treatment.Results Among the 21 patients in treatment group,14（66.6%）had improved intra-abdominal hypertension,3 died,and 4 were discharged from hospital.Among the 16 patients in control group,3（18.7%）had improved intra-abdominal hypertension,9 died,and 4 were discharged from hospital.Compared with control group,continuous hemofiltration significantly improve the indexes of renal function and the levels of lactic acid,HCO-3 ,troponin I,CRP, TNF-αand IL-6,and decreased the mortality（P 〈0.05）.Conclusion CBP can ameliorate symptoms,reduce intra-abdominal pressure,improve prognosis and decrease mortality in patients with the third-space fluid retention-based intra-abdominal hypertension or ACS.