不同肾功能水平下腹内压及腹腔灌注压对危重患者肾功能的影响  

The effect of intra - abdominal pressure and abdominal perfusion pressure in patients with different level of kidney function in ICU

作　　者：谷欣[1] 余静喜 王青凤[1] 王湘江[1] 龙宏杰[1] 

机构地区：[1]惠州市第三人民医院ICU,广东惠州516000

出　　处：《中国急救医学》2014年第9期806-810,共5页Chinese Journal of Critical Care Medicine

基　　金：广东省卫生厅医学科学技术研究基金项目（WSTJJ20111224430202198008144077）

摘　　要：目的探讨不同。肾功能水平下腹内压（IAP）及腹腔灌注压（APP）对危重患者肾功能的影响。方法选取2012—05～2013—09我院收治的ICU患者120例，根据患者的基础肾功能分为。肾功能异常组70例和肾功能正常组50例，采用膀胱测压法测量ICU患者的IAP和APP，同时采用Logistic回归分析急性肾衰竭（ARF）发生的相关危险因素，并根据ROC曲线求得预测ARF发生的临界IAP值、APP值。结果肾功能异常组的IAP值为（17．54±5．58）mmHg高于正常组，APP值为（65．45±11．60）mmHg低于正常组（均P〈0．05），且肾功能异常组ARF发生率为40．28％，明显高于正常组10．00％（P〈0．01）。Logistic回归分析表明，患者的体位、APACHEII评分、SOFA评分、血管活性药的使用史、IAP、APP是ARF发生的独立危险因素。根据ROC曲线分析，预测ARF发生的临界IAP值、APP值分别为21．64mmHg和55．80mmHg。结论危重患者IAP及APP存在明显个体差异，体位、APACHEⅡ评分、SOFA评分、血管活性药的使用史、IAP、APP是影响患者发生ARF的危险因素，而IAP及APP可作为ICU患者预测ARF发生的关键性指标之一，特别是对于肾功能有异常的患者将具有重大的参考价值。Objective To discuss the effect of intra - abdominal pressure （IAP） and abdominal perfusion pressure （APP） in patients with different level of kidney function in ICU. Methods One hundred and twenty cases of ICU patients from May 2012 to September 2013 were selected and divided into abnormal renal function group （70 cases） and normal renal function group （50 cases） by the basis of renal function. The IAP and APP of the ICU patients were measured through monitoring the bladder pressures. At the same time, Logistic regression was used to analyze the correlative risk factors for acute renal failure （ARF）. The IAP and APP critical value predicted ARF were obtained according to the ROC curve. Results The IAP of abnormal renal function group （ 17.54 ± 5.58 ）mm Hg was higher than that of normal group ; the APP of abnormal renal function group （65.45 ± 11.60） mm Hg was lower than normal group; comparative differences between two groups are of statistical significance （P 〈 O. 05 ）. The incidence of ARF in abnormal renal function group was 40.28% , significantly higher than that in the normal group （ P 〈 0.01 ）. Logistic regression analysis shows that body position, APACHE II score, SOFA score, vascular active drug use history, IAP, APP were independent risk factors for the occurrence of ARF. According to the ROC curve analysis, the IAP and APP critical value predicted ARF were 21.64 mm Hg and 55.80 mm Hg, respectively. Conclusion The IAP and APP in ICU patients are of great individual difference. The body position, APACHE Ⅱ score, SOFA score, vascular active drug use history, IAP and APP are the risk factors in patients with ARF; IAP and the APP can be usedas key indicators to predict ARF occurrence in ICU patients, especially in patients with abnormal renal function.

关 键 词：腹内压 腹腔灌注压 ICU 肾功能 

分 类 号：R692.5[医药卫生—泌尿科学]