急性创伤性休克患者腹内压增高时血流动力学监测指标的变化

Changes of hemodynamic in patients with acute traumatic shock with increased intra-abdominal pressure

目的评估急性创伤致休克患者腹内压(腹腔内压力,IAP)增高时血流动力学各监测指标的变化情况。方法选取80例急性创伤后致休克患者在急救过程中进行腹内压监测,每4 h监测一次,连续监测48 h,根据腹内压监测结果分为2组,即腹内压正常组22例(IAP<12 mmHg)和腹内压增高组58例(IAP≥12 mmHg),并同时监测2组患者呼吸频率(R)、心率(HR)、中心静脉压(CVP)、平均动脉压(MBP)、心输出量(CO)、血氧饱和度(SpO_(2))、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、尿量等值。结果58例腹内压增高组患者的R为(32.45±5.31)次/min,HR为(110.78±7.21)次/min,CVP为(8.78±1.83)cmH 2O,MBP为(105.74±4.29)mmHg,PaCO_(2)为(55.64±6.18)mmHg;而22例腹内压正常组的R为(28.24±4.35)次/min,HR为(102.64±5.21)次/min,CVP为(6.23±1.56)cmH 2O,MBP为(100.15±6.56)mmHg,PaCO_(2)为(48.56±5.41)mmHg;2组比较差异有统计学意义(P<0.05)。58例腹内压增高组患者的CO为(3.01±1.08)L/min,SpO_(2)为(89.32±7.93)%,PaO_(2)为(115.2±14.25)mmHg,尿量为(14.31±5.45)mL/h;22例腹内压正常组的CO为(5.36±1.12)L/min,SPO_(2)为(95.72±8.23)%,PaO_(2)为(137.12±11.15)mmHg,尿量为(24.23±4.65)mL/h,腹内压增高组明显低于腹内压正常组(P<0.05)。结论创伤失血性休克患者IAP监测值增高时明显影响患者血流动力学的监测指标。

Objective To evaluate the changes of hemodynamic in patients with acute traumatic shock when intra-peritoneal pressure(IAP)increased.Methods 80 cases of acute traumatic shock patients with intra-abdominal pressure were selected in emergency process monitoring,and intra-abdominal pressure was monitored every four hours,and then 48 hours continuous monitoring.And 22 cases(intra-abdominal pressure<12 mmHg)as normal group,58 cases of intra-abdominal pressure was greater than 12 mmHg judged to be internal high pressure group,the breathing rate(R),heart rate(HR),central venous pressure(CVP),mean arterial pressure(MBP),cardiac output(CO),blood oxygen saturation(SpO_(2)),oxygen partial pressure(PaO_(2)),CO_(2) partial pressure(PaCO_(2))and urine volume were monitored.Results The R(32.45±5.31)bpm,HR(110.78±7.21)bpm,CVP(8.78±1.83)cmH 2O,MBP(105.74±4.29)mmHg,PaCO_(2)(55.64±6.18)mmHg in the group with increased abdominal pressure was significantly higher than those in the group with normal abdominal pressure(P<0.05);The CO(3.01±1.08)L/min,SpO_(2)(89.32±7.93)%,PaO_(2)(115.2±14.25)mmHg and urine volume(14.31±5.45)mL/h in the group with increased intra-abdominal pressure were significantly lower than those in the normal group(P<0.05).Conclusion Hemodynamics of traumatic hemorrhagic shock patients is significantly affected by increased intra-abdominal pressure.