腹内压、腹腔灌注压与肝硬化合并感染性休克患者预后关系的临床研究  

Relationship amongintroabdominal pressure,abdominal perfusion pressure,and hepatocirrhosis complicated with septic shock:a clinical research for prognosis

作　　者：张翌[1] 蔡逊[1] 曹庭加[1] 金炜东[1] 

机构地区：[1]广州军区武汉总医院普通外科

出　　处：《临床外科杂志》2015年第12期916-919,共4页Journal of Clinical Surgery

摘　　要：目的探讨腹内压（intro-abdominal pressure，IAP）、腹腔灌注压（abdominal perfusion pressure，APP）与肝硬化合并感染性休克患者临床预后的关系。方法收集61例肝硬化合并感染性休克患者的临床资料，包括IAP，APP，病死率，机械通气、血管活性药物使用及撤离时问，血液透析使用情况等临床指标，分析IAP，APP与患者临床预后的关系，评价IAP，APP对肝硬化合并感染性休克患者临床预后的预测价值。结果患者入院当日平均IAP（16．7±3．9）mmHg，发生腹内高压50例（81．97％），腹腔间隔室综合征9例（14．75％），平均动脉压（meanateria Jpressure，MAP）〈60mmHg39例（63．93％）。根据lAP记录值（〈12mmHg，≥12mmHg）、APP记录值（〈60mmHg，≥60mmHg）对患者进行分组，组间患者ICU入住时间、总体住院时间、住院病死率相比，差异无统计学意义，IAP／〉12mmHg组患者ICU病死率较高，与IAP〈12mmHg组相比组间差异有统计学意义（P〈0．05）。IAP≥12mmHg及APP〈60mmHg组患者机械通气、血管活性药物使用时间较长，组间差异有统计学意义（P〈0．05）；腹内高压（intra-abdominal hypertension，IAH）、腹腔低灌注（abdominal hypoperfusion，AH）是肝硬化感染性休克患者人住ICU期间及住院期间病死的危险因素。结论APP与IAH及腹腔间隔室综合征（abdominal compartment syndrome，ACS）的患者病死风险相关；IAP升高与患者肝功能损害、腹腔脏器灌注不足及患者相关并发症的发生风险有关；肝硬化感染性休克患者MAP较低，IAH发生率较高，常导致APP低，MAP、APP是该类患者病死风险的独立危险因素，其敏感性、特异性均较高。Objective To investigate the relationship arnongintroabdominal pressure （ IAP）, abdominal perfusion pressure （APP）, and prognosis for hepatocirrhosis patients complicated with septic shock. Methods The clinical data of 61hepatocirrhosis patients with septic shock,including IAP, APP, mortality rate, mechanical ventilation, administration of vasoactive drugs, andhemodialysis were reviewed for evaluating the correlation and prognostic values of lAP and APP for septic shock. Results The aver- ageIAP on the admission day was （ 16.7 _＋ 3.9 ） mmHg. There were 50 cases （ 81.97% ） with a high IAP,9 cases with abdominal compartment syndrome （ACS）, and 39 cases （63.93 % ） with a mean arteri- al pressure（MAP） less than 60 mmHg. 1＇here wereno significant differences in ICU stay,hospital stay and mortality rate between IAP and APP patients. Patients with high IAP（ I〉 12mmHg） have higher mortality rates in ICU（P 〈0.05）. Patients with high IAP（~〉12mmHg） and low APP （〈60mmHg） usedmechani- cal ventilation and vasoactive drugs for a longer time （ P 〈 0.05 ）. Intraabdominal hypertension（IAH） and abdominal hypopeffusion （AH） were risk factors for hepatoeirrhosis patients with septic shock during the hospitalization. Conclusion APP is related to the mortality risk of IAH and ACS;high IAP is related to the risk of hepatic dysfunction, AH, and related complications ; hepatocirrhosis patients complicated with septic shock have a lower MAP and a higher incidence of IAH,which may result a lower APP. The sensi- bility and specificity of MAP and APP are high, and theyare the independent risk factors for septic shock in hepatocirrhosis patients.

关 键 词：腹内压 腹腔灌注压 平均动脉压 肝硬化 感染性休克 

分 类 号：R459.7[医药卫生—急诊医学] R575.2[医药卫生—治疗学]