持续性血液净化治疗对腹腔内高压患者的胃肠功能障碍的影响  

Clinical study of the influence of continuous hemofiltration on gastrointestinal dysfunction of the patients with intra-abdominal hypertension

作　　者：须欣[1] 黄曼[1] 王鹏飞[1] 徐秋萍[2] 

机构地区：[1]浙江大学医学院附属第二医院综合ICU,杭州310009 [2]浙江大学医学院附属邵逸夫医院危重症医学科

出　　处：《中华急诊医学杂志》2014年第10期1138-1142,共5页Chinese Journal of Emergency Medicine

基　　金：浙江省科技厅资助项目（2011C23080）

摘　　要：目的 观察连续性血液净化治疗（CBP）治疗腹腔内高压（IAH）患者过程中对胃肠功能障碍的影响.方法 37例IAH患者分两组,治疗组20例,予以CBP治疗72 h;对照组17例予以常规治疗,在治疗0,24,72 h及第7天,测量腹腔内压力,统计胃肠道症状数目,计算后序贯器官衰竭评分（SOFA）评分.结果 接受CBP治疗后患者平均动脉压（MAP）无明显变化（P=0.218）,腹腔内压（IAP）显著下降（P=0.001）,腹腔灌注压（APP）也较前明显升高（P=0.036）;CBP组与对照组相比,入选24h后有2个以上胃肠道症状的患者比例明显降低（P=0.049）,而72 h后CBP组有2个以上和3个以上胃肠道症状的患者比例均低于对照组（P＜0.05）;接受CBP治疗后序贯器官衰竭评分（SOFA）评分较对照组明显下降（P =0.037）;两组患者的28d及60 d病死率差异无统计学意义.结论 CBP治疗能降低IAP,从而使APP升高,改善内脏血供,使肠道功能显著恢复;本研究提示CBP治疗对患者预后无明显改善,但早期可改善腹腔高压患者胃肠道功能不全.Objective To investigate the effects of continuous hemofihration on gastrointestinal dysfunction for treating patients with intra-abdominal hypertension.Methods A total of 37 patients were divided into two groups randomly （random number）,namely control group （n =17） and continuous blood filtration （CBF） group （n =20）.The patients of control group were treated with routine treatment,and the patients of CBF group were given CBF for 72 hours in addition to the routine treatment.The intra-abdominal pressure （IAP）,gastrointestinal （GI） symptoms,and SOFA score were documented at 0 hour,24 hours,72 hours and 7 days after treatment.Results The MAP of patients in the CBF group was not significantly changed （P =0.218）,while the IAP was decreased significantly （P =0.001） and the abdominal perfusion pressure （APP） increased significantly after CBF （P =0.036）.Compared with the control group,there were more than 2 GI symptoms markedly relieved after CBF for 24 hours （P =0.049）.The SOFA score of CBF group decreased significantly （P =0.037）.There were no differences in 28-day and 60-day mortality between two groups.Conclusions The CBF can decrease IAP,increase APP,improve splanchnic blood circulation,and ameliorate gastrointestinal dysfunction.But CBF does not reduce the mortality in comparison with routine treatment.

关 键 词：血液净化 腹腔高压 胃肠功能障碍 

分 类 号：R459.5[医药卫生—治疗学]