基于专利套件改良的经膀胱腹内压监测方法在SAP患者中的应用效果评价

Application effect evaluation of improved transvesical intra-abdomincal pressure monitoring method based on patent kit in SAP patients

目的研制并评价基于一次性密闭式膀胱测压套件改良的经膀胱腹内压(IAP)监测方法在重症急性胰腺炎(SAP)患者IAP监测及其指导肠内营养(EN)的应用效果,为其推广应用提供循证医学证据。方法基于临床经验研制出一次性密闭式膀胱测压套件(专利号:ZL202020552480.3),并基于该套件制定改良经膀胱IAP监测方法(改良方法)。以在陆军军医大学第二附属医院消化内科住院治疗的182例SAP患者为研究对象。对71例有尿患者同时采用改良方法和传统方法进行连续5 d的IAP监测,对25例无尿患者采用改良方法进行IAP监测,评价套件监测的有效性;同时将需要进行EN的86例SAP患者采用随机数字表法(按1∶1)分为改良方法组和传统方法组,各43例,根据监测结果指导EN的临床实施,比较持续EN 1周后的临床效果。结果在有尿SAP患者中,改良方法在各时间点IAP测定值与传统方法比较,差异无统计学意义(P>0.05),且对无尿患者的膀胱IAP能有效监测。改良方法组患者EN不耐受率显著低于传统方法组,同时改良方法组患者的饮食达标率、体重指数增加量均显著高于传统方法组,差异均有统计学意义(P<0.05)。结论一次性密闭式膀胱测压套件对有尿和无尿的SAP患者均能有效地进行经膀胱IAP监测,基于该套件改良的经膀胱IAP监测技术能有效指导SAP患者的EN动态调节,该套件及基于其的改良监测方法值得进一步评价和临床推广应用。

Objective To develop and evaluate the application effect of the improved transvesical intra-abdomincal pressure(IAP)monitoring method based on the disposable closed bladder manometer kit in monitoring IAP and guiding enteral nutrition(EN)in patients with severe acute pancreatitis(SAP),so as to provide evidence-based medical evidence for its widespread application.Methods Based on the clinical experience,the disposable closed bladder manometer kit(Patent number:ZL202020552480.3)was developed,and based on this kit,the improved transvesical IAP monitoring method(improved method)was developed.A total of 182 patients with SAP who were hospitalized in the Department of Gastroenterology of the Second Affiliated Hospital of Army Military Medical University were studied.A total of 71 patients with urination were monitored by the improved method and the traditional method for consecutive five days,and 25 patients without urination were monitored by the improved method to evaluate the effectiveness of the manometer kit.At the same time,86 SAP patients requiring EN were divided into the improved method group and the traditional method group(43 cases each)by random number table method(1∶1).The clinical implementation of EN was guided according to the monitoring results,and the clinical effect after continuous EN 1 week was compared.Results In SAP patients with urination,IAP values measured by the improved method at different time points showed no statistical significance compared with those measured by the traditional method(P>0.05),and the improved method could effectively monitor the transvesical IAP in patients without urination.The EN intolerance rate of patients in the improved method group was significantly lower than that in the traditional method group,and the diet compliance rate and body mass index increase of patients in the improved method group were significantly higher than those in the traditional method group,with statistical significance(P<0.05).Conclusion The disposable closed bladder manometer kit can effectively monitor the transvesical IAP in SAP patients with and without urine.The improved transvesical IAP pressure monitoring technology based on the kit can effectively guide the dynamic regulation of EN in SAP patients.The kit and the improved monitoring method based on it are worthy of further evaluation and clinical application.