超声引导下经皮穿刺引流对重症急性胰腺炎患者腹腔压力的影响:一项回顾性病例对照研究  

Clinical effect of ultrasound-guided percutaneous drainage on intra-abdominal pressure in patients with severe acute pancreatitis:a retrospective case-control study

作　　者：邹赛男 张晓菲[1] 廖艺[1] 杨洋 王丽纯[1] 陈雷[1] ZOU Sainan;ZHANG Xiaofei;LIAO Yi;YANG Yang;WANG Lichun;CHEN Lei(The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院,广东广州510655

出　　处：《现代医院》2022年第12期1962-1965,共4页Modern Hospitals

基　　金：广东省基础与应用基础研究基金(2019A1515011723)。

摘　　要：目的探讨超声引导经皮穿刺引流(percutaneous catheter drainage,PCD)对重症急性胰腺炎患者腹腔内压的改善效果。方法选取2014年1月—2021年12月期间收入ICU重症急性胰腺炎并进行超声引导下PCD治疗的患者,收集患者的基本情况,记录和分析超声引导下PCD治疗前后腹腔压力变化的情况,并观察重要器官功能和支持治疗变化的情况,以及超声引导下PCD的并发症和住院资源利用情况等。结果32例重症急性胰腺炎患者最终纳入研究,91%存在腹腔高压,28天死亡率为19%。在超声引导下PCD有效组中,操作前腹腔内压≥15 mmHg的患者比例显著高于无效组(77%vs 30%,P=0.01);操作前、后腹腔内压的下降幅度更加明显[(6.45±1.75)vs(0.15±2.32)mmHg,P<0.001]。超声引导下PCD有效组患者的血肌酐下降程度明显大于无效组[(33.51±48.96)vs(-1.91±57.02)μmol/L,P=0.048]。超声引导下PCD前、后腹腔压力下降与操作前IAP≥15 mmHg、操作前血肌酐、操作前后血肌酐差、操作前儿茶酚胺药物剂量、机械通气时间和连续肾脏替代治疗时间相关。结论对于腹腔内压在2级及以上的重症急性胰腺炎患者,超声引导下的PCD可以更好地控制腹腔内压,更快地恢复肾脏功能。Objective To investigate the effect of ultrasound-guided percutaneous catheter drainage(PCD)on intra-abdominal pressure(IAP)in patients with severe acute pancreatitis(SAP).Methods We select patients with severe acute pancreatitis who were admitted to ICU and underwent ultrasound-guided PCD treatment from January 2014 to December 2021,collect their basic information,analyze the changes of abdominal pressure before and after ultrasound-guided PCD treatment,and observe the changes of important organ functions and supportive treatment,as well as the complications of ultrasound-guided PCD and the utilization of inpatient resources.Results 32 patients with SAP were finally included in the study.91%had intra-abdominal hypertension(IAH),and the 28-day mortality rate was 19%.In the effective group of ultrasound-guided PCD,the proportion of patients with IAP≥15 mmHg before operation was significantly higher than that in the ineffective group(77%vs 30%,P=0.01),and the IAP decreased significantly more[(6.45±1.75)vs(0.15±2.32)mmHg,P<0.001].Moreover,the decrease of serum creatinine in the effective group of ultrasound-guided PCD was significantly more than that in the ineffective group[(33.51±48.96)vs(-1.91±57.02)μmol/L,P=0.048].The decrease of IAP before and after ultrasound-guided PCD is associated with IAP above 15mmHg before PCD,serum creatinine before,serum creatinine changes before and after PCD,catecholamine dosage before,mechanical ventilation duration and CRRT duration.Conclusion For SAP patients with IAP of grade 2 or above,ultrasound-guided PCD can better control IAP and recover renal function faster.

关 键 词：经皮穿刺引流 重症急性胰腺炎 腹腔高压 治疗效果 

分 类 号：R459.7[医药卫生—急诊医学]