液体复苏量与急性重症胰腺炎患者腹内高压及肾脏损害的关系

Correlation of fluid resuscitation volume with intra-abdominal hypertension and renal injury in patients with severe acute pancreatitis

目的探讨液体复苏量与急性重症胰腺炎(SAP)腹内高压(IAH)及肾脏损害的关系。方法以60例SAP患者为研究对象,以AbViser法测量腹内压(IAP),根据IAP将研究对象分为正常组、IAH组和腹腔间隔室综合征(ACS)组,统计分析各组的一般情况、死亡率、液体复苏量及肾功能损害情况。结果 (1)本研究中IAH发病率为31.67%(19/60),ACS发病率为11.67%(7/60)。正常组、IAH组和ACS组死亡率分别为5.88%(2/34)、21.05%(4/19)和57.14%(4/7),ACS组死亡率高于正常组(P=0.007)。(2)正常组、IAH组和ACS组3日液体平衡量分别为(4 350±892)、(5 512±1 246)和(5 974±1 765)mL,组间比较差异有统计学意义(P<0.001);总液体累积量分别为(8 530±2 384)、(9 403±2 064)、(13 172±2 409)mL,组间比较差异有统计学意义(P<0.001)。其中ACS组3日液体平衡量及液体累积量均为最高。(3)正常组、IAH组和ACS组肾功能生化指标血肌酐、尿素氮组间差异均具有统计学意义(P<0.001),ACS组血肌酐、尿素氮水平均高于正常组及IAH组(P<0.05)。结论 SAP患者前3日液体累积量与IAH甚至ACS的发生密切相关,而IAH将进而导致SAP患者肾功能损伤。

Objective To investigate the correlation of fluid resuscitation volume with intra-abdominal hypertension（IAH）and renal injury in patients with severe acute pancreatitis（SAP）.Methods Totally 60 patients with SAP from our ICU were recruited in the present study.The intra-abdominal pressure（IAP）was measured by method AbViser.The patients were divided into the following 3groups according to the different of IAP：the normal group,IAH group and abdominal compartment syndrome（ACS）group.The general information,mortality rate,fluid resuscitation volumes and renal injury were analyzed and compared in the 3groups.Results（1）The incidence rates of IAH and ACS in our study were 31.67%（19/60）and 11.67%（7/60）,respectively.The mortality rates of normal group,IAH group and ACS group were 5.88%（2/34）,21.05%（4/19）and 57.14%（4/7）,respectively.The mortality rate of ACS group was significantly higher than that of normal group（P=0.007）.（2）The fluid balance volumes of normal group,IAH group and ACS group were（4 350±892）,（5 512±1 246）and（5 974±1 765）mL,respectively,with significant differences found among the 3groups（P〈0.001）;the total cumulative fluid volumes of the 3groups were（8 530±2 384）,（9 403±2 064）and（13 172±2 409）mL,respectively,also with significant differences found among the 3groups（P〈0.001）.ACS group had the highest fluid balance and total cumulative fluid volumes in the first 3days.（3）There were significant differences in the levels of blood creatinine and urea nitrogen among the 3groups（P〈0.001）.The levels of blood creatinine and urea nitrogen of ACS group was significantly higher than those of normal group and IAH group（P〈0.05）.Conclusion The cumulative fluid of the first 3days is associated with IAH and even ACS in pateints with SAP,and IAH can further lead to renal injury in patients with SAP.