重症患者腹内高压的危险因素及预后分析

Risk factors for intra-abdominal hypertension and prognostic analysis among adult intensive care unit patients

目的对重症患者在综合ICU住院期间腹内高压（IAH）的分类危险因素（CRF）进行探讨，并对相关预后进行临床分析。方法根据病患的人选及排除标准，选取2014—09—2015—04在宁波市第一医院重症医学科住院的163例重症患者进行分析。按照2014年世界腹腔间隙学会（WSACS）公布的指南，将IAH危险因素分为以下四类：腹壁顺应性下降、胃肠腔内容物增加、腹腔内容物增加以及毛细血管渗漏综合征／大量液体复苏。如果入选患者中有两类以上（包括两类）的危险因素，即进行每日常规定时腹腔内压（IAP）监测。收集数据包括：患者基本情况、APACHEⅡ评分、SOFA评分、每日液体平衡情况、每日平均IAP、5dIAH缓解情况、ICU住院时间、总住院时间、液体正平衡情况及病死率等。结果163例患者中共计有103例（63．2％）拥有两类或以上CRF，将这些患者定义为IAH高危患者，其中71例（68．9％）进展为IAH，与未进展为IAH患者比较，IAH患者死亡率显著增高（31．0％VS．12．5％，P〈0．05），同时，IAH患者体质量指数、ICU入住时间、总住院时间及液体正平衡例数均显著增加。在IAH患者中，5d内IAH不能缓解患者病死率（87．5％）显著增高。结论综合性ICU中大量患者拥有高腹压危险因素，具有两类或以上危险因素的患者有较大可能进展为IAH，同时病死率显著增加。因此，对于IAH高危患者，应按照2014年WSACS指南推荐行常规IAP监测，尽早采取有效措施防治腹腔间隔综合征（ACS）。

Objective The aim of this study was to determine the relationship between the incidence of intra-abdominal hypertension （IAH） in patients and categorized risk factors （CRF） for IAH, and to analyze the prognosis of these high-risk patients. Methods According to the criteria of selection and exclusion, 163 patients among our adult intensive care unit from September 2014 to April 2015 were recruited. Through ICU whole staff training, we conducted daily screening of the four CRF for IAH based on the World Society of Abdominal Compartment Syndrome （WSACS） guidelines （namely, diminished abdominal wall compliance, increased intraluminal content, increased abdominal content, capillary leak syndrome or fluid resuscitation）. If the categorized risk factors in those patients were at least two different categories （≥2CRF）, intra-abdominal pressure （IAP） was measured every 8 hours during ICU stay. Data included demographics, severity score, Sequential Organ Failure Assessment （SOFA） score, cumulative fluid balance, daily mean IAP, resolution of IAH, days of ICU and hospital stay, and mortality. Resuits 103 patients （63.2%） had at least two CRF for IAH who we called high-risk IAH patients. In all, 71 patients developed IAH. Patients with IAH had a significantly higher mortality rate （31.0% vs 12.5%, P〈 0.05）. What＇s more, patients with IAH had higher body mass index, days of ICU/hospital stay, cumulative fluid balance and morality rate. Non-resolution of IAH in five days was associated with a higher mortality rate （87.5%）. Conclusion Critically ill patients admitted to ICU had high CRF for IAH. The patients who had at least two CRF for IAH were more likely to develop into IAH. The highrisk IAH patients had high mortality rate, so IAP should be conventionally measured and monitored as recommended by WSACS so that we can take early and effective means for prevention and treatment of IAH.