维库溴铵治疗腹腔间隔室综合征的临床价值研究

Clinical study of using vecuronium treat patients with abdominal compartment syndrome

目的探讨维库溴铵治疗腹腔间隔室综合征（abdominalcompartmentsyndrome，ACS）的临床价值及对预后的影响。方法将ICU中40例ACS患者随机分为治疗组与对照组（每组20例）。对照组采取抗感染、胃肠减压、镇静镇痛、促胃肠动力药物、机械通气、血液净化、外科手术等常规治疗，治疗组在对照组基础上加用肌松剂（维库溴铵）间断静注或持续微量泵输注。观察、对比使用维库溴铵治疗对腹腔压力、腹腔灌注压、血压、血乳酸、尿量、氧合指数、C反应蛋白、APACHEⅡ评分、ICU住院时间及病死率的影响及相互变化的关系。结果维库溴铵能明显降低腹腔压力、腹腔灌注压和血乳酸水平（P〈0．05），提高氧合指数（P〈0．05），但对人住ICU时间及病死率无明显影响。结论维库溴铵可明显改善ACS患者的腹腔压力，短期内可延缓病情进展，但对总体预后无明显影响。

Objective To investigate the clinical value of using vecuronium treat patients with abdominal compartment syndrome and the factors that affect prognosis. Methods Forty cases with abdominal compartment syndrome in the ICU were randomly divided into treatment group （20 cases） and control group （20 cases）. Patients in control group were treated by anti -infection, gastrointestinal decompression, sedation, prokinetic drugs, mechanical ventilation, blood purification, surgery and other conventional treatment. Based on the above treatment, treatment group using muscular blockers vecuronium intermittent intravenous infusion or continuous micro - pump. Dynamic change of intra - abdominal pressure, abdominal perfusion pressure, blood pressure, blood lactate, urine output, oxygenation index, C - reactive protein levels, APACHE Ⅱ score were determined, and ICU stay and hospital mortality were recorded and compared between the two groups. Results For patients with abdominal compartment syndrome vecuronium can not only effectively lower abdominal pressure, abdominal perfusion pressure, blood lactate （ P 〈 0.05 ）, but also improve arterial oxygenation index （P 〈 0. 05 ）. However, no significant effect of vecuronium was shown on ICU stay and hospital mortality. Conclusion Vecuronium significantly improves the intra - abdominal pressure and delays the progress of the disease in the short term in patients with abdominal compartment syndrome, but does not affect the overall prognosis.