腹内压变化率在急性肠梗阻患者急性肾损伤中的预测价值

Predictive value on intra-abdominal pressure change rate of acute kidney injury in patients with acute intestinal obstruction

目的：探讨腹内压变化率在急性肠梗阻患者急性肾损伤中的预测价值。方法选取2012年6月~2014年6月广东省惠州市第三人民医院收治的急性肠梗阻患者120例作为观察组,另选取30例同期健康查体者作为对照组。根据腹内压变化率,将观察组又分为A亚组（腹内压变化率〉20%,n=26）、B亚组（腹内压变化率为原20%~20%,n=53）和C亚组（腹内压变化率〈原20%,n=41）。比较观察组和对照组的平均腹内压及腹内压变化率,检测观察组血肌酐和24 h尿量变化,根据检测结果判断急性肠梗阻患者急性肾损伤的发生情况,采用ROC曲线分析腹内压变化率对性肠梗阻患者急性肾损伤的预测价值。结果观察组第1天平均腹内压、第3天平均腹内压和腹内压变化率均显著高于对照组,差异有高度统计学意义（P〈0.01）。与A、B亚组比较,C亚组第1~7天血肌酐均降低,24 h尿量均升高,差异有统计学意义（P〈0.05）；与A亚组比较,B亚组第1~7天血肌酐均降低,24 h尿量均升高,差异有统计学意义（P〈0.05）。 C亚组急性肾损伤发生率为26.83%,低于A、B亚组的53.85%和39.62%,B亚组急性肾损伤发生率亦低于A亚组,差异有统计学意义（P〈0.05）。腹内压变化率预测急性肠梗阻患者急性肾损伤的ROC曲线下面积、灵敏度、特异度和准确性分别为0.778、94.48%、74.68%和95.26%。结论腹内压变化率在急性肠梗阻患者中升高,且对急性肾损伤预测价值良好,对腹内压变化率较高的急性肠梗阻患者,需及时进行肾功能检测,以早期发现或预防急性肾损伤的发生。

Objective To investigate predictive value on intra-abdominal pressure change rate of acute kidney injury in patients with acute intestinal obstruction. Methods 120 patients with acute intestinal obstruction treated in the Third People’s Hospital of Huizhou City in Guangdong Province from June 2012 to June 2014 were selected as observation group. 30 cases of healthy persons in the same period were selected as control group. Observation group was divided into subgroup A （intra-abdominal pressure change rate 〉 20%, n = 26）, subgroup B （intra-abdominal pressure change rate from-20%to 20%, n=53） and subgroup C （intra-abdominal pressure change rate 〈-20%, n=41） according to intra-abdominal pressure change rate. Average intra-abdominal pressure and intra-abdominal pressure change rate be-tween observation group and control group were compared. Serum creatinine and 24 h urine volume changes of obser-vation group were tested, the occurrence of acute kidney injury was diagnosed according to test result. ROC curve was used to analyze value of intra-abdominal pressure change rate predicting the occurrence of acute renal injury in pa-tients with acute intestinal obstruction. Results Average intra-abdominal pressure in the 1st and the 3rd day and intra-abdominal pressure change rate of observation group was significantly higher than that of control group respectively, and the difference was statistically significant （P〈0.01）. Compared with subgroup A and subgroup B, serum creatinine levels at 1-7 d of subgroup C were reduced, 24 h urine volume of subgroup C were increased, with statistical difference （P〈 0.05）. Compared with subgroup A, serum creatinine levels at 1-7 d of subgroup B were reduced, 24 h urine vol-ume of subgroup B were increased, with statistical differ-ence （P〈0.05）. Incidence rate of acute kidney injury in subgroup C was 26.83%, lower than that in subgroup A＆amp;nbsp;and subgroup B （53.85% and 39.62%） respectively, incidence rate of acute kidney injury in subgroup B was lower than that in subgroup A, with statistical difference （P〈0.05）. Area under the ROC curve, sensitivity, specific and the accu-racy of abdominal intra-abdominal pressure change rate predicting the occurrence of acute kidney injury in acute in-testinal obstruction patients was 0.778, 94.48%, 74.68% and 95.26% respectively. Conclusion Intra-abdominal pres-sure change rate in patients with acute intestinal obstruction is rose and its predictive value on the occurrence of acute kidney in jury is good, thus acute intestinal obstruction patients with higher intra-abdominal pressure change rate should be timely tested to find out early change of renal function and prevent the occurrence of acute kidney injury.