CAJ | 학술논문

目的：探讨不同时机腹腔灌洗治疗对重症急性胰腺炎并腹腔高压患者疗效的影响。方法68例确诊重症急性胰腺炎（SAP）并腹腔高压（IAH）患者根据发病至开始腹腔灌洗治疗的不同时机分成 A 组（发病≤24 h 灌洗组，n ＝20）、B 组（发病＞24 h～≤48 h 内灌洗组，n ＝26）和 C 组（发病＞48 h～≤72 h 内灌洗组，n ＝22）。患者腹腔灌洗治疗前及治疗后1周进行急性生理学和慢性健康评分（APACHE-Ⅱ），记录患者灌洗治疗前及治疗第7天腹腔内压水平。结果3组经7 d 腹腔灌洗治疗后 APACHE-Ⅱ评分及腹腔内压水平较灌洗前均显著下降（P ＜0．01）；随着开始腹腔灌洗时间的延迟，经7 d 腹腔灌洗后的APACHE-Ⅱ评分及腹腔内压降低的程度在逐步减小（P ＜0．05），且A组腹腔内压下降程度较B组更为显著（P ＜0．05）。结论24 h 内开始腹腔灌洗是腹腔灌洗治疗重症急性胰腺炎并腹腔高压的最佳时机。
목적：탐토불동시궤복강관세치료대중증급성이선염병복강고압환자료효적영향。방법68례학진중증급성이선염（SAP）병복강고압（IAH）환자근거발병지개시복강관세치료적불동시궤분성 A 조（발병≤24 h 관세조，n ＝20）、B 조（발병＞24 h～≤48 h 내관세조，n ＝26）화 C 조（발병＞48 h～≤72 h 내관세조，n ＝22）。환자복강관세치료전급치료후1주진행급성생이학화만성건강평분（APACHE-Ⅱ），기록환자관세치료전급치료제7천복강내압수평。결과3조경7 d 복강관세치료후 APACHE-Ⅱ평분급복강내압수평교관세전균현저하강（P ＜0．01）；수착개시복강관세시간적연지，경7 d 복강관세후적APACHE-Ⅱ평분급복강내압강저적정도재축보감소（P ＜0．05），차A조복강내압하강정도교B조경위현저（P ＜0．05）。결론24 h 내개시복강관세시복강관세치료중증급성이선염병복강고압적최가시궤。
Objective To explore the influence of peritoneal lavage therapy at different time on efficacy of severe acute pancreatitis (SAP)patients with intra-abdominal hypertension (IAH). Methods 68 SAP patients with IAH were divided into 3 groups according to time of peritoneal lavage therapy,including group A (n =20,≤24 hours),group B (n =26,>24 hours~≤ 48 hours)and group C (n =22,>48 hours~≤72 hours).APACHE-Ⅱscore was calculated and in-tra abdominal pressure (IAP)was measured before treatment and 7 days after peritoneal lavage therapy.Results APACHE-Ⅱscore and IAP 7 days after peritoneal lavage therapy in all groups decreased significantly (P <0.01).Along with the time delay of peritoneal lavage,the decline of APACHEII score and IAP 7 days after peritoneal lavage decreased gradually (P <0.05).7 days af-ter peritoneal lavage treatment,the degree of decline of IAP in group A was significantly greater than group B (P <0.05).Conclusion Application of peritoneal lavage therapy within 24 hours is the best time for treatment of SAP patients with IAH.