腹腔开放疗法用于非创伤重症患者临床价值的多中心回顾性研究  

Clinical value of open abdomen therapy in non-traumatic critically patients:a multicenter retrospective study

作　　者：阎小雨 任炳魁 黄伟鹏 郭丰[4] 童文星 郑祥德 薛霖 李双玲[7] 陈咏怡 刘向阳[8] 段军[8] 许璐 常志刚[1] Yan Xiaoyu;Ren Bingkui;Huang Weipeng;Guo Feng;Tong Wenxing;Zheng Xiangde;Xue Lin;Li Shuangling;Chen Yongyi;Liu Xiangyang;Duan Jun;Xu Lu;Chang Zhigang(Department of Critical Care Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine of Chinese Academy of Medical Sciences,Beijing100730,China;Beijing Hospital,National Center of Gerontology,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing100730,China;Provincial Key Laboratory of Precise Diagnosis and Treatment of Abdominal Infection,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou310016,China;Department of Critical Care Medicine,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou310016,China;Department of Clinical Medicine,North Sichuan Medical College,Nanchong 637100,Chnia;Department of Critical Care Medicine,Dazhou Central Hospital,Dazhou635099,China;Department of Critical Care Medicine,Peking University First Hospital,Beijing100035,China;Depart-ment of Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,Chnia;Support Center of Data Science,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine of Chinese Academy of Medical Sciences,Beijing100730,China)

机构地区：[1]北京医院重症医学科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京医院、国家老年医学中心、北京协和医学院、中国医学科学院,北京100730 [3]浙江大学医学院附属邵逸夫医院、全省腹腔感染精准诊疗重点实验室,杭州310016 [4]浙江大学医学院附属邵逸夫医院重症医学科,杭州310016 [5]川北医学院临床医学系,南充637100 [6]达州市中心医院重症医学科,达州635099 [7]北京大学第一医院重症医学科,北京100035 [8]中日友好医院重症医学科,北京100029 [9]北京医院科研处数据科学支持中心、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华消化外科杂志》2024年第11期1416-1422,共7页Chinese Journal of Digestive Surgery

基　　金：国家重点研发计划(2023YFC3011803)。

摘　　要：目的探讨腹腔开放疗法用于非创伤重症患者的临床价值。方法采用回顾性队列研究方法。收集2015年7月至2024年7月我国北京医院等5家医学中心收治的23例行腹腔开放疗法非创伤重症患者的临床资料;男17例,女6例;年龄为70(24~84)岁。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。重复测量数据采用重复测量方差分析,组内两两比较采用最小显著差异法。应用Boruta算法进行生存结局相关变量分析。结果(1)行腹腔开放疗法患者的治疗情况。①23例患者术前至术后第3天腹内压、乳酸、心率、中心静脉压、平均动脉压、序贯器官衰竭评分分别由(19.7±5.4)mmHg(1 mmHg=0.133 kPa)、(6.1±1.9)mmol/L、(120±14)次/min、(13.1±4.3)cmH 2O(1 cmH 2O=0.098 kPa)、(58.8±6.8)mmHg、(13.2±1.8)分变化至(10.6±1.3)mmHg、(2.3±0.6)mmol/L、(95±10)次/min、(8.8±2.0)cmH 2O、(75.2±8.5)mmHg、(10.1±1.6)分,上述指标变化趋势时间效应比较,差异均有统计学意义(F_(时间)=46.40,29.19,24.91,11.84,27.81,11.71,P<0.05)。②23例患者术前至术后第3天氧合指数、总入量、总出量分别由(255.0±54.2)mmHg、(5388±1562)mL、(2520±630)mL变化至(291.7±25.0)mmHg、(2886±866)mL、(3221±923)mL,上述指标变化趋势时间效应比较,差异均有统计学意义(F_(时间)=7.61,13.83,2.97,P<0.05)。③23例患者术后第1天至第3天每日补充热卡量、每日补充蛋白质分别由(465±116)kcal、(18±5)g变化至(1628±472)kcal、(60±18)g,上述指标变化趋势时间效应比较,差异均有统计学意义(F_(时间)=40.31,41.23,P<0.05)。(2)行腹腔开放疗法患者的治疗结局。23例患者中,生存18例、死亡5例。23例患者重症医学科入住时间为26(5~82)d,总住院时间为40(5~98)d。23例患者中,12例接受肾脏替代治疗,治疗时间为12(5~32)d。23例患者均进行镇痛镇静治疗、机械通气治疗、抗菌药物治疗、血管活性药�Objective To investigate the clinical value of open abdomen therapy in non-traumatic critically patients.Methods The retrospective cohort study was conducted.The clinical data of 23 non-traumatic critically patients who underwent open abdomen therapy in 5 hospitals in China from July 2015 to July 2024 were collected.There were 17 males and 6 females,aged 70(range,24-84)years.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Repeated measurement data were analyzed using the repeated ANOVA,and pairwise comparison within groups was conducted using the least significant difference method.The Boruta algorithm was applied for analyzing variables related to survival outcomes.Results(1)Treatment of patients undergoing open abdomen therapy.①The intra-abdominal pressure,lactate,heart rate,central venous pressure,mean arterial pressure,sequential organ failure assessment score of 23 patients from preoperation to postoperative day 3 were changed from(19.7±5.4)mmHg(1 mmHg=0.133 kPa),(6.1±1.9)mmol/L,(120±14)beats/minutes,(13.1±4.3)cmH 2O(1 cmH 2O=0.098 kPa),(58.8±6.8)mmHg,13.2±1.8 to(10.6±1.3)mmHg,(2.3±0.6)mmol/L,(95±10)beats/minutes,(8.8±2.0)cmH 2O,(75.2±8.5)mmHg,10.1±1.6,respectively,showing significant differences in the time effect of changes in the above indicators(F_(time)=46.40,29.19,24.91,11.84,27.81,11.71,P<0.05).②The oxygenation index,total intake,total output of 23 patients from preoperation to postoperative day 3 were changed from(255.0±54.2)mmHg,(5388±1562)mL,(2520±630)mL to(291.7±25.0)mmHg,(2886±866)mL,(3221±923)mL,respectively,showing significant differences in the time effect of changes in the above indicators(F_(time)=7.61,13.83,2.97,P<0.05).③The daily caloric intake,daily protein supplementation of 23 patients from preoperation to postoperative day 3 were changed from(465±116)kcal,(18±5)g to(1628±472)kcal,(60±18)g,respectively,showing signifi

关 键 词：重症 腹腔开放 腹腔高压 腹腔感染 营养支持 疗效 

分 类 号：R459.7[医药卫生—急诊医学]