腹腔内压监测在危重患者中的临床应用  

The monitoring of intra-abdominal pressure in critically ill patients

作　　者：伊敏[1] 么改琦[1] 白宇[1] 

机构地区：[1]北京大学第三医院危重医学科,100191

出　　处：《中华危重病急救医学》2014年第3期175-178,共4页Chinese Critical Care Medicine

基　　金：首都医学发展科研基金（2009-1034）;北京大学第三医院基金（69468-01）

摘　　要：目的 探讨腹腔内压（IAP）监测在危重患者中的应用.方法 采用前瞻性队列研究方法,以膀胱测压法监测北京大学第三医院危重医学科重症监护病房（ICU）住院危重患者的IAP,筛查IAP≥12 mmHg（1 mmHg=0.133 kPa）的腹腔内高压（IAH）患者,并对IAH、腹腔间隔室综合征（ACS）患者按标准流程进行系统管理.将入选患者分为IAH组与非IAH组、生存组与死亡组,分别比较患者的平均动脉压（MAP）、IAP、腹腔灌注压（APP）、渗透梯度（FG）和血清肌酐（SCr）.结果 共监测88例患者的IAP,其中25例发生IAH（发生率28.4％）,2例发生ACS（发生率2.3％）；死亡8例（病死率9.1％）,出院时生存80例（生存率90.9％）.与非IAH患者比较,IAH患者的IAP、SCr显著升高[IAP （mmHg）：14.16±2.43比8.13±2.28,t=10.984,P=0.000；SCr（μmol/L）：126.72±83.02比73.41±37.59,t=3.087,P=0.005],FG显著降低（mmHg：59.32±17.08比70.24±15.03,t=-2.956,P=0.004）,而MAP、APP无明显差异[MAP（mmHg）：79.18±12.33比88.71±17.34,t=-1.368,P=0.190; APP（mmHg）：73.40±16.11比78.37±14.32,t=-1.415,P=0.161].与生存组比较,死亡组患者APP、FG显著降低[APP（mmHg）：60.88±14.58比78.56±14.06,t=3.382,P=0.001；FG（mmHg）：50.38±16.18比68.81±15.44,t=3.208,P=0.002],SCr显著升高（μmol/L：129.12±83.62比84.36±55.15,t=-2.082,P=0.040）,而MAP、IAP均无显著差异[MAP （mmHg）：71.00±25.46比84.38±13.53,t=1.224,P=0.238; IAP（mmHg）：10.62±5.34比9.76±3.40,t=-0.647,P=0.519].结论 对住ICU的危重患者进行IAP测量,可以早期发现IAH和ACS;按照标准的IAP评估筛查系统和IAH/ACS管理系统,采取适当的预防措施,将有望改善患者的预后.Objective - To monitor intra-abdominal pressure （IAP） in critically ill patients. Methods A prospective cohort study was conducted. IAP was measured through the bladder technique. Patients were screened for intra-abdominal hypertension （IAH, IAP ≥ 12 mmHg, 1 mmHg= 0.133：kPa） upon ICU admission. The patients with IAH/abdominal compartment syndrome （ACS） were given appropriate treatment and management for IAH and/or ACS. Mean arterial pressure （MAP）, IAP, abdominal perfusion pressure （APP）, filtration gradien[ （FG） and serum creatinine （Cr） were determined in patients with or without IAH, as Well as in survivors and non-survivors. Results The entire protocol of IAP measurement was completed in 88 patients. Number of IAH and ACS patients was 25 （28.4%） and 2 （2.3%）, respectively. The number of survivors was 80 （90.9%）, with 8 （9A%） non-survivors. Compared with non-IAH patients, IAP and SCr were increased in IAH patients [IAP （mmHg）： 14.16 ± 2.43 vs. 8.13 ± 2.28, t=10.984, P=0.000; SCr （umol/L）： 126.72 ± 83.02 vs. 73.41 ± 37.59, t=3.087, P=0.005], with a lower FG （mmHg： 59.32 ± 17.08 vs. 70.24 ± 15.03, t=-2.956, P=0.004）. There were no significant differences in MAP and APP between IAH group and non-IAH group [MAP （mmHg）： 79.18 ± 12.33 vs. 88.71 ± 17.34, t=-1.368, P=0.190; APP （mmHg）： 73.40 ± 16.11 vs. 78.37 ± 14.32, t=-1.415, P=0.1613. Compared with survivors, non-survivors showed significantly lower APP and FG [APP （mmHg） ： 60.88 ± 14.58 vs. 78.56 ± 14.06, t=3.382, P=0.001 ; FG （mmHg）： 50.38 ± 16.18 vs. 68.81 ± 15.44; t=3.208, p=0.0023, and higher SCr （ umol/L： 129.12 ± 83.62 vs. 84.36 ± 55.15, t=-2.082, P=0.040）. There was no significant difference in IAP and MAP between survivors and non-survivors [MAP （mmHg）： 71.00 ±25.46 vs. 84.38± 13.53, t=1.224, P=0.238; IAP （mmHg）： 10.62 ± 5.34 vs. 9.76 ± 3.40, t=-0.647, P=0.5193. Conclusions Earlier IAP measurements in critically ill patients ar

关 键 词：腹腔内压监测 腹腔内高压 腹腔间隔室综合征 危重患者 

分 类 号：R459.7[医药卫生—急诊医学]