急诊ICU患者腹内压监测及危险因素观察

Monitoring and risk factors of intra abdominal hypertension in EICU patients

目的：本研究旨在讨论急诊ICU患者腹内压监测的注意事项以及腹高压危险因素的观察，以评估患者腹高压对预后的影响。方法分析58例急诊ICU急性期住院患者的临床资料，使用膀胱内测压确定腹内压。统计分析患者年龄、性别、入院第一个24 h液体平衡以及入院72 h内以下参数：平均动脉压（ MAP ）、APA-CHEII评分、红细胞压积、血肌酐、白细胞数、血钙、血糖、国际标准化比值（ INR）、C-反应蛋白、白蛋白值等因素与腹内压的相关性，并根据患者入院时测定的腹内压值，分析腹内压对患者病死率、手术率、住院时间及病死率等预后指标的影响。结果腹内压多因素Logistic回归分析显示入院第一个24 h液体平衡、APACHEⅡ评分、白蛋白值是急诊ICU患者发生腹内压升高的独立危险因素；而腹高压的发生对患者感染率、手术率、血管活性药物使用、机械通气、急性肾损伤、住院时间及病死率等预后指标产生显著影响。结论急诊ICU患者腹内压的升高与多个因素有关，入院24 h液体平衡、APACHEⅡ评分、白蛋白值是急诊ICU患者发生IAH的独立危险因素。腹高压的程度对急诊ICU患者器官功能及预后产生明显影响。腹高压监测时应注意水温、注水速度及测压管中的气泡，以免影响测量结果。加强监测急诊ICU患者的腹内压，及时解除可能引起腹内压升高的危险因素是治疗的重要环节之一。

Objective To investigate the risk factors of intra abdominal hypertension （ IAH） in EICU patients and assess the prognosis of EICU patients with IAH. Methods The clinical data of patients were analyzed and internal bladder pressure was used to measure IAH, multivariate logistic regression analysis was applied to analyze the indexes including age, gender, Acute Physiology and Chronic Health Evaluation Ⅱ scores （ APACHE Ⅱ） , 24-hour fluid balance, hematocrit, serum calcium level and so on. Clinical prognosis such as mortality, hospital duration, etc. of patients with or without IAH were also compared. Results First 24-hour fluid balance, APACHE Ⅱ and serum albumin level were found to be independent risk factors for IAH in patients. Moreover, patients with IAH had significantly longer average length of hospital and intensive care unit duration, higher rates of systemic and local complications and more invasive treatments. Conclusion The results of this study are in favor of relief these risk factors in patients with IAH in early time.