目的 探讨腹腔内压(IAP)监测在危重患者中的应用.方法 采用前瞻性队列研究方法,以膀胱测压法监测北京大学第三医院危重医学科重症监护病房(ICU)住院危重患者的IAP,筛查IAP≥12 mmHg(1 mmHg=0.133 kPa)的腹腔内高压(IAH)患者,并对IAH、腹腔间隔室综合征(ACS)患者按标准流程进行系统管理.将入选患者分为IAH组与非IAH组、生存组与死亡组,分别比较患者的平均动脉压(MAP)、IAP、腹腔灌注压(APP)、渗透梯度(FG)和血清肌酐(SCr).结果 共监测88例患者的IAP,其中25例发生IAH(发生率28.4％),2例发生ACS(发生率2.3％)；死亡8例(病死率9.1％),出院时生存80例(生存率90.9％).与非IAH患者比较,IAH患者的IAP、SCr显著升高[IAP (mmHg):14.16±2.43比8.13±2.28,t=10.984,P=0.000；SCr(μmol/L):126.72±83.02比73.41±37.59,t=3.087,P=0.005],FG显著降低(mmHg:59.32±17.08比70.24±15.03,t=-2.956,P=0.004),而MAP、APP无明显差异[MAP(mmHg):79.18±12.33比88.71±17.34,t=-1.368,P=0.190; APP(mmHg):73.40±16.11比78.37±14.32,t=-1.415,P=0.161].与生存组比较,死亡组患者APP、FG显著降低[APP(mmHg):60.88±14.58比78.56±14.06,t=3.382,P=0.001；FG(mmHg):50.38±16.18比68.81±15.44,t=3.208,P=0.002],SCr显著升高(μmol/L:129.12±83.62比84.36±55.15,t=-2.082,P=0.040),而MAP、IAP均无显著差异[MAP (mmHg):71.00±25.46比84.38±13.53,t=1.224,P=0.238; IAP(mmHg):10.62±5.34比9.76±3.40,t=-0.647,P=0.519].结论 对住ICU的危重患者进行IAP测量,可以早期发现IAH和ACS;按照标准的IAP评估筛查系统和IAH/ACS管理系统,采取适当的预防措施,将有望改善患者的预后.
目的 探討腹腔內壓(IAP)鑑測在危重患者中的應用.方法 採用前瞻性隊列研究方法,以膀胱測壓法鑑測北京大學第三醫院危重醫學科重癥鑑護病房(ICU)住院危重患者的IAP,篩查IAP≥12 mmHg(1 mmHg=0.133 kPa)的腹腔內高壓(IAH)患者,併對IAH、腹腔間隔室綜閤徵(ACS)患者按標準流程進行繫統管理.將入選患者分為IAH組與非IAH組、生存組與死亡組,分彆比較患者的平均動脈壓(MAP)、IAP、腹腔灌註壓(APP)、滲透梯度(FG)和血清肌酐(SCr).結果 共鑑測88例患者的IAP,其中25例髮生IAH(髮生率28.4％),2例髮生ACS(髮生率2.3％)；死亡8例(病死率9.1％),齣院時生存80例(生存率90.9％).與非IAH患者比較,IAH患者的IAP、SCr顯著升高[IAP (mmHg):14.16±2.43比8.13±2.28,t=10.984,P=0.000；SCr(μmol/L):126.72±83.02比73.41±37.59,t=3.087,P=0.005],FG顯著降低(mmHg:59.32±17.08比70.24±15.03,t=-2.956,P=0.004),而MAP、APP無明顯差異[MAP(mmHg):79.18±12.33比88.71±17.34,t=-1.368,P=0.190; APP(mmHg):73.40±16.11比78.37±14.32,t=-1.415,P=0.161].與生存組比較,死亡組患者APP、FG顯著降低[APP(mmHg):60.88±14.58比78.56±14.06,t=3.382,P=0.001；FG(mmHg):50.38±16.18比68.81±15.44,t=3.208,P=0.002],SCr顯著升高(μmol/L:129.12±83.62比84.36±55.15,t=-2.082,P=0.040),而MAP、IAP均無顯著差異[MAP (mmHg):71.00±25.46比84.38±13.53,t=1.224,P=0.238; IAP(mmHg):10.62±5.34比9.76±3.40,t=-0.647,P=0.519].結論 對住ICU的危重患者進行IAP測量,可以早期髮現IAH和ACS;按照標準的IAP評估篩查繫統和IAH/ACS管理繫統,採取適噹的預防措施,將有望改善患者的預後.
목적 탐토복강내압(IAP)감측재위중환자중적응용.방법 채용전첨성대렬연구방법,이방광측압법감측북경대학제삼의원위중의학과중증감호병방(ICU)주원위중환자적IAP,사사IAP≥12 mmHg(1 mmHg=0.133 kPa)적복강내고압(IAH)환자,병대IAH、복강간격실종합정(ACS)환자안표준류정진행계통관리.장입선환자분위IAH조여비IAH조、생존조여사망조,분별비교환자적평균동맥압(MAP)、IAP、복강관주압(APP)、삼투제도(FG)화혈청기항(SCr).결과 공감측88례환자적IAP,기중25례발생IAH(발생솔28.4％),2례발생ACS(발생솔2.3％)；사망8례(병사솔9.1％),출원시생존80례(생존솔90.9％).여비IAH환자비교,IAH환자적IAP、SCr현저승고[IAP (mmHg):14.16±2.43비8.13±2.28,t=10.984,P=0.000；SCr(μmol/L):126.72±83.02비73.41±37.59,t=3.087,P=0.005],FG현저강저(mmHg:59.32±17.08비70.24±15.03,t=-2.956,P=0.004),이MAP、APP무명현차이[MAP(mmHg):79.18±12.33비88.71±17.34,t=-1.368,P=0.190; APP(mmHg):73.40±16.11비78.37±14.32,t=-1.415,P=0.161].여생존조비교,사망조환자APP、FG현저강저[APP(mmHg):60.88±14.58비78.56±14.06,t=3.382,P=0.001；FG(mmHg):50.38±16.18비68.81±15.44,t=3.208,P=0.002],SCr현저승고(μmol/L:129.12±83.62비84.36±55.15,t=-2.082,P=0.040),이MAP、IAP균무현저차이[MAP (mmHg):71.00±25.46비84.38±13.53,t=1.224,P=0.238; IAP(mmHg):10.62±5.34비9.76±3.40,t=-0.647,P=0.519].결론 대주ICU적위중환자진행IAP측량,가이조기발현IAH화ACS;안조표준적IAP평고사사계통화IAH/ACS관리계통,채취괄당적예방조시,장유망개선환자적예후.
Objective To monitor intra-abdominal pressure (IAP) in critically ill patients.Methods A prospective cohort study was conducted.IAP was measured through the bladder technique.Patients were screened for intra-abdominal hypertension (IAH,IAP ≥ 12 mmHg,1 mmHg=0.133 kPa) upon ICU admission.The patients with IAH/abdominal compartment syndrome (ACS) were given appropriate treatment and management for IAH and/or ACS.Mean arterial pressure (MAP),IAP,abdominal perfusion pressure (APP),filtration gradient (FG) and serum creatinine (Cr) were determined in patients with or without IAH,as well as in survivors and non-survivors.Results The entire protocol of IAP measurement was completed in 88 patients.Number of IAH and ACS patients was 25 (28.4％) and 2 (2.3％),respectively.The number of survivors was 80 (90.9％),with 8 (9.1％) non-survivors.Compared with non-IAH patients,IAP and SCr were increased in IAH patients [IAP (mmHg):14.16 ± 2.43 vs.8.13 ± 2.28,t=10.984,P=0.000; SCr (μmol/L):126.72 ± 83.02 vs.73.41 ± 37.59,t=3.087,P=0.005],with a lower FG (mmHg:59.32 ± 17.08 vs.70.24 ± 15.03,t=-2.956,P=0.004).There were no significant differences in MAP and APP between IAH group and non-IAH group [MAP (mmHg):79.18 ± 12.33 vs.88.71 ± 17.34,t=-1.368,P=0.190; APP (mmHg):73.40 ± 16.11 vs.78.37 ± 14.32,t=-1.415,P=0.161].Compared with survivors,non-survivors showed significantly lower APP and FG [APP (mmHg):60.88 ± 14.58 vs.78.56 ± 14.06,t=3.382,P=0.001 ; FG (mmHg):50.38 ± 16.18 vs.68.81 ± 15.44,t=3.208,P=0.002],and higher SCr (μmol/L:129.12 ±83.62 vs.84.36 ± 55.15,t=-2.082,P=0.040).There was no significant difference in IAP and MAP between survivors and non-survivors [MAP (mmHg):71.00 ± 25.46 vs.84.38 ± 13.53,t =1.224,P=0.238 ; IAP (mmHg):10.62 ±5.34 vs.9.76 ± 3.40,t=-0.647,P=0.519].Conclusions Earlier IAP measurements in critically ill patients are essential for the detection of IAH/ACS and renal injury.With appropriate management of IAH/ACS,significant decrease in morbidity and mortality of patients has been achieved.
