CAJ | 학술논문

目的：探讨连续性血液滤过（CBP）治疗以第三间隙液体潴留为主的腹腔高压及腹腔间隙综合征（ACS）的疗效。方法37例诊断为以第三间隙液体潴留为主的腹腔高压或腹腔间隙综合征的患者按是否进行血液滤过分为治疗组（21例）和对照组（16例），对照组采用胃肠减压、镇痛等常规治疗，治疗组采用在常规治疗基础上给予连续性血液滤过治疗，1次·d-1，5次。记录比较治疗前后腹内压、氧合指数、平均动脉压、APACHEⅡ评分、生化指标以及 TNF-α、IL-6，和 C-反应蛋白（CRP）的水平。观察治疗前、治疗后患者一般情况及生化指标、炎症介质的变化，计算死亡率。结果治疗组14例腹腔高压好转，3例死亡，4例自动出院，好转率66．6％；对照组腹腔高压好转3例，死亡9例，自动出院4例，好转率18．7％。治疗组肾功能指标、乳酸、HCO-3、肌钙蛋白 I（cTnI）及炎症介质CRP、TNF-α、IL-6改善明显优于对照组，病死率明显低于对照组（P ＜0．05）。结论CBP 可明显改善以第三间隙液体潴留为主的腹腔高压或腹腔间隙综合征的症状，降低腹内压，改善预后，降低死亡率。
목적：탐토련속성혈액려과（CBP）치료이제삼간극액체저류위주적복강고압급복강간극종합정（ACS）적료효。방법37례진단위이제삼간극액체저류위주적복강고압혹복강간극종합정적환자안시부진행혈액려과분위치료조（21례）화대조조（16례），대조조채용위장감압、진통등상규치료，치료조채용재상규치료기출상급여련속성혈액려과치료，1차·d-1，5차。기록비교치료전후복내압、양합지수、평균동맥압、APACHEⅡ평분、생화지표이급 TNF-α、IL-6，화 C-반응단백（CRP）적수평。관찰치료전、치료후환자일반정황급생화지표、염증개질적변화，계산사망솔。결과치료조14례복강고압호전，3례사망，4례자동출원，호전솔66．6％；대조조복강고압호전3례，사망9례，자동출원4례，호전솔18．7％。치료조신공능지표、유산、HCO-3、기개단백 I（cTnI）급염증개질CRP、TNF-α、IL-6개선명현우우대조조，병사솔명현저우대조조（P ＜0．05）。결론CBP 가명현개선이제삼간극액체저류위주적복강고압혹복강간극종합정적증상，강저복내압，개선예후，강저사망솔。
Objective To evaluate the efficacy of continuous blood purification(CBP)in the treatment of the third-space fluid retention-based intra-abdominal hypertension and abdominal compartment syndrome(ACS).Methods Thirty-seven patients diagnosed with the third-space fluid retention-based intra-abdominal hypertension or ACS were divided into two groups.The control group(n = 16)received gastrointestinal decompression,analgesia and other conventional therapies.On the basis of conventional therapies,the treatment group(n=21)was given continu-ous hemofiltration therapy once daily for at least 5 days.Intra-abdominal pressure,oxygenation index,mean arterial pressure,APACHE II score,mortality rate,biochemical index and levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)were recorded before and after treatment.Results Among the 21 patients in treatment group,14(66.6%)had improved intra-abdominal hypertension,3 died,and 4 were discharged from hospital.Among the 16 patients in control group,3(18.7%)had improved intra-abdominal hypertension,9 died,and 4 were discharged from hospital.Compared with control group,continuous hemofiltration signifi-cantly improve the indexes of renal function and the levels of lactic acid,HCO-3 ,troponin I,CRP, TNF-αand IL-6,and decreased the mortality(P <0.05).Conclusion CBP can ameliorate symp-toms,reduce intra-abdominal pressure,improve prognosis and decrease mortality in patients with the third-space fluid retention-based intra-abdominal hypertension or ACS.