危重患者腹腔内高压的发生率及其危险因素评估

Incidence of intra-abdominal hypertension and its risk foctors in critically ill patients

目的探讨危重患者腹腔内高压（IAH）的发病率及相关危险因素.方法采用前瞻性研究方法,对2013年7～11月期间入住广州市第-人民医院重症加强护理病房（ICU）的54例危重患者,经膀胱尿管间接测定腹腔内压力,记录人口学特征、入住ICU时的主要诊断、是否辅助通气及呼气末正压值、腹部手术情况、临床检验结果、腹围、中心静脉压、液体平衡、危重评分等指标,并采用logistic回归分析探讨IAH的危险因素.结果危重患者的IAH发生率为37.0%（20/54）,其中Ⅰ级10例,Ⅱ级8例,Ⅲ级2例,Ⅳ级0例.IAH患者较非IAH患者拥有较高急性生理与慢性健康评分[（20.1±6.2）分,（14.9±5.6）分,t=8.04,P=0.000]、贯续器官衰竭估计评分[（10.4±6.4）分,（5.5±4.3）分,t=7.31,P〈0.05]及中心静脉压[（10.4±2.8）mmHg,（8.9±2.0）mmHg,t=6.21,P〈0.05]（1mmHg=0.133kpa）,相关危险因素有机械通气、腹腔积液、感染性休克、胆道疾病（均P〈0.05）.结论ICU危重患者的IAH发生率较高,且以轻中度为主,与机械通气、腹腔积液、感染性休克及胆道系统疾病密切相关.

Objective To discuss the incidence of intra-abdominal hypertension (IAH)and its risk factors in critically ill patients.Methods Prospective cohort study was carried out in our general intensive care unit (ICU).A total of fifty-four patients were enrolled between July 201 3 and November 201 3.Intra-abdominal pressure (IAP)was measured though the urinary bladder catheter indirectly.Indicators including demographics,main diagnosis on admission,mechanically ventilated and the PEEP (positive end-expiratory pressure),laparotomy,clinical test results,CVP,cumulative fluid balance,severity scores and so on were recorded.Logistic regression analysis was used to investigate risk factors of IAH.Risk factors of IAH were analyzed by logistic regression.Results In our study,the incidence of IAH in critical patients was 37.0%(20 /54),including ten persons in Grade Ⅰ,eight persons in Grade Ⅱ,two persons in Grade Ⅲ,none in Grade Ⅳ.Higher acute physiology and chronic health scores (APACHE-Ⅱ)[(20.1 ±6.2)scores,(1 4.9 ±5.6)scores,t =8.04,P <0.05],Sequential organ failure assessment (SOFA)scores [(1 0.4 ±6.4) scores,(5.5 ±4.3)scores,t =7.31 ,P <0.05],central venous pressure[(1 0.4 ±2.8)mmHg,(8.9 ± 2.0)mmHg,t =6.21 ,P <0.05)]were measured in patients with IAH than those in patients without IAH. Risk factors associated with IAH were mechanical ventilation,ascites,septic shock and disorders of biliary system(P <0.05).Conclusions The high incidence of IAH is observed in ICU critical patients,mainly in&nbsp;mild and moderate degree.And a close correlation is found between IAH and its risk factors including mechanical ventilatia ascites,septic shock and disorders of biliary system.