超声在腹腔间室综合征患者管理中的应用研究  

The utilization of ultrasound in the management of patients with abdominal compartment syndrome

作　　者：林竹[1] 高红梅[1] 许华 骆宁[1] 李红洁[1] 赵秀宝[1] 胡英山 刘海生 LIN Zhu;GAO Hong-mei;XU Hua(Department of Intensive Care Unit,Tianjin First Center Hospital,Tianjin Institute of Emergency Medicine,Tianjin 300192,China)

机构地区：[1]天津急救医学研究所,天津市第一中心医院重症医学科,天津300192 [2]河北省唐山市玉田县中医医院重症医学科,唐山064100

出　　处：《中国中西医结合外科杂志》2025年第1期37-41,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：天津市医学重点学科建设项目(TJYXZDXK-013A);天津市科技计划项目(21JCYBJC00090);河北省中药管理局科研计划项目(T2025009)。

摘　　要：目的:探索超声在腹腔间室综合征(ACS)患者管理中的作用。方法:选取2023年7月—2024年6月我院重症医学科收治的30例ACS患者为研究对象,接受超声作为ACS管理的辅助工具。结果:30例ACS患者的年龄为(60.0±14.6)岁,男性占70%,平均体质量指数(BMI)为(25.0±2.4)kg/m^(2),80%的ACS患者合并低血压需应用升压药物,ACS最常见的原因是腹腔感染导致的脓毒症和肠梗阻,分别占40%和20%。连续治疗5 d,平均腹腔内压力(IAP)从入院时(23±2.3)mmHg,下降至第5天(13±2.2)mmHg(P <0.001)。患者第1天平均APP为(62±5.5)mmHg,治疗第5天升为(90±5.4)mmHg(P <0.001),尿量从第4天开始明显增加,且伴随肾动脉阻力指数下降至(0.65±0.06)(P <0.001)。超声提示第1天出现肠道功能障碍的患者有10例,占总患者的33.3%,经胃肠减压、灌肠等处理后,第5天仅有1例患者仍存在肠道功能障碍;超声可以识别肠腔内容物,进一步指导患者减压或灌肠,同时对于8例合并腹腔积液的患者,进行了超声引导穿刺术。结论:在ACS患者治疗管理中,相比传统应用腹腔灌注压(APP)评估腹腔内器官的灌注,经超声测量的肾动脉阻力指数可以更加敏感地评估肾脏的灌注;超声在评估肠道功能,识别肠腔内容物,指导进行减压、灌肠,引导腹腔积液引流管的放置方面均有优势。Objective To explore the role of ultrasonography in the management of patients with abdominal compartment syndrome(ACS).Methods Thirty patients diagnosed with ACS were included as research subjects,employing ultrasonography as an auxiliary tool for ACS management.Results The study encompassed 30 patients,with an average age of(60.0±14.6) years,70% of whom were male,and an average BMI of(25.0±2.4)kg/m~2.Eighty percent of the patients with ACS required vasopressor support due to hypotension,with the most common causes of ACS being sepsis due to intra-abdominal infection,and intestinal obstruction,accounting for 40% and 20% respectively.After five consecutive days of treatment,the average intra-abdominal pressure(IAP)decreased from(23±2.3)mmHg at admission to(13±2.2)mmHg on the fifth day.The patient's average APP on the first day was(62±5.5)mmHg,which rose to(90±5.4)mmHg by the fifth day of treatment.However,a significant increase in urine output was observed starting from the third day,accompanied by a decrease in the renal artery resistance index to(0.65±0.06).Ultrasound indicated intestinal dysfunction in 10 patients(33.3% of the total) on the first day,which was reduced to one patient by the fifth day following gastrointestinal decompression and enema treatments;ultrasonography could identify intestinal contents,further guiding decompression or enema procedures.Additionally,for eight patients with concurrent ascites,ultrasound-guided paracentesis was performed.Conclusion In the treatment and management of patients with ACS,compared to the traditional application of APP for assessing perfusion of intra-abdominal organs,the renal artery resistance index measured by ultrasonography can more sensitively evaluate renal perfusion.Ultrasound has advantages in evaluating intestinal function,identifying contents within the intestinal lumen,guiding decompression and enema administration,and guiding the placement of abdominal fluid drainage tubes.

关 键 词：超声 腹腔内高压 腹腔间室综合征 

分 类 号：R656.5[医药卫生—外科学]