腹腔内压与急性重症胰腺炎预后的临床相关性研究  

Clinical Study of Intra-abdominal Pressure in Prognosis of Patient with Severe Acute Pancreatitis

作　　者：司晔巍[1] 周开国[1] 李大鹏[1] 曹秋梅[1] 

机构地区：[1]首都医科大学附属北京同仁医院急诊科,北京100176

出　　处：《中国医药导刊》2015年第12期1212-1214,共3页Chinese Journal of Medicinal Guide

摘　　要：目的探讨腹腔内压与急性重症胰腺炎预后的相关性及手术时机的选择.方法：收集2008年1月至2014年1月期间就诊于我院急诊科的急性重症胰腺炎（severe acute pancreatitis,SAP）患者38例,腹腔内压（intra-abdominal pressure,IAP）均〉7mmhg.根据IAP的大小分为3组,分别为A组（7～12mmHg）、B组（12～20mmHg）、C组（〉20mmHg）,记录相关临床数据并进行急性生理学与慢性健康状况评分（APACHEⅡ）.比较各组最大APACHE Ⅱ评分、C-反应蛋白（C-response protein,CRP）、脏器功能不全发生率、ICU住院时间和住院病死率、早期手术干预与保守治疗的死亡率.结果：C组患者在ICU住院时间、住院病死率、最大APACHE Ⅱ评分、CRP、脏器功能不全发生率方面都大于A组,住院病死率,心血管功能不全发生率大于B组,差异具有统计学意义（P〈0/05）.C组早期手术干预病死率显著低于非手术组,为早期干预组病死数/总数（1/5）,非手术组病死数/总数（4/4）,差异具有统计学意义（P〈0.05）.结论：腹腔压力有助于判断SAP的预后,是SAP严重程度的标志之一.建议当急性重症胰腺炎出现IAP〉20mmHg时可以考虑手术减压.Objective: To investigate the correlation between the intra-abdominal pressure and prognosis of patients with severe acute pancreatitis and the timing of the operation.Methods: 38 cases of patients with severe acute pancreatitis (severe acute pancreatitis,SAP) in the hospital emergency department into the research of data integrity during January 2008 to January 2008,the intra-abdominal pressure (intra - abdominal pressure,IAP)>7 mmHg.According to the size of the IAPit was divided into 3 groups: group A (7~12 mmHg),group B (12~20 mmHg),group C (>20 mmHg),respectively.Record the related clinical data and acute physiology and chronic health evaluation (APACHEⅡ).Comparison maximum APACHEⅡ score,and C - reactive protein (C-response protein,CRP),the incidence of organ dysfunction,length of ICU-hospital stay and the incidence of hospital mortality,the mortality of early surgical intervention and conservative treatment between groups.Results:Group C of patients is greater than in group A on the length of ICU hospital stay,hospital mortality,maximum APACHEⅡ score,CRP,the incidence of organ dysfunction, the hospital mortality and the incidence of cardiovascular dysfunction is greater than in group B,the difference is statistically significant,P<0.05. The mortality of early surgical intervention in group C was significantly lower than those who did not,for total death number/total number the early intervention group(1/5),those who did not (4/4),statistically significant difference,P<0.05).Conclusion: Abdominal pressure helps to judge the prognosis of SAP,is one of the symbols of the severity of SAP.Advice when there is IAP>20 mmHg severe acute pancreatitis surgical decompression can be considered.

关 键 词：重症急性胰腺炎 腹内压 腹内高压症 腹腔间隙综合征 预后 

分 类 号：R576[医药卫生—消化系统]