中国急救医学
中國急救醫學
중국급구의학
CHINESE JOURNAL OF CRITICAL CARE MEDICINE
2014年
9期
806-809,810
,共5页
谷欣%余静喜%王青凤%王湘江%龙宏杰
穀訢%餘靜喜%王青鳳%王湘江%龍宏傑
곡흔%여정희%왕청봉%왕상강%룡굉걸
腹内压%腹腔灌注压%ICU%肾功能
腹內壓%腹腔灌註壓%ICU%腎功能
복내압%복강관주압%ICU%신공능
Intra-abdominal pressure%Abdominal perfusion pressure%ICU%Kidneyfunction
目的：探讨不同肾功能水平下腹内压（ IAP）及腹腔灌注压（ APP）对危重患者肾功能的影响。方法选取2012-05～2013-09我院收治的ICU患者120例，根据患者的基础肾功能分为肾功能异常组70例和肾功能正常组50例，采用膀胱测压法测量ICU患者的IAP和APP，同时采用Logistic回归分析急性肾衰竭（ ARF）发生的相关危险因素，并根据ROC曲线求得预测ARF发生的临界IAP值、APP值。结果肾功能异常组的IAP值为（17．54±5．58）mm Hg高于正常组，APP值为（65．45±11．60）mm Hg低于正常组（均P＜0．05），且肾功能异常组ARF发生率为40．28％，明显高于正常组10．00％（P＜0．01）。 Logistic回归分析表明，患者的体位、APACHEⅡ评分、SOFA评分、血管活性药的使用史、IAP、APP是ARF发生的独立危险因素。根据ROC曲线分析，预测ARF发生的临界IAP值、APP值分别为21．64 mm Hg和55．80 mm Hg。结论危重患者IAP及APP存在明显个体差异，体位、APACHEⅡ评分、SOFA评分、血管活性药的使用史、IAP、APP是影响患者发生ARF的危险因素，而IAP及APP可作为ICU患者预测ARF发生的关键性指标之一，特别是对于肾功能有异常的患者将具有重大的参考价值。
目的：探討不同腎功能水平下腹內壓（ IAP）及腹腔灌註壓（ APP）對危重患者腎功能的影響。方法選取2012-05～2013-09我院收治的ICU患者120例，根據患者的基礎腎功能分為腎功能異常組70例和腎功能正常組50例，採用膀胱測壓法測量ICU患者的IAP和APP，同時採用Logistic迴歸分析急性腎衰竭（ ARF）髮生的相關危險因素，併根據ROC麯線求得預測ARF髮生的臨界IAP值、APP值。結果腎功能異常組的IAP值為（17．54±5．58）mm Hg高于正常組，APP值為（65．45±11．60）mm Hg低于正常組（均P＜0．05），且腎功能異常組ARF髮生率為40．28％，明顯高于正常組10．00％（P＜0．01）。 Logistic迴歸分析錶明，患者的體位、APACHEⅡ評分、SOFA評分、血管活性藥的使用史、IAP、APP是ARF髮生的獨立危險因素。根據ROC麯線分析，預測ARF髮生的臨界IAP值、APP值分彆為21．64 mm Hg和55．80 mm Hg。結論危重患者IAP及APP存在明顯箇體差異，體位、APACHEⅡ評分、SOFA評分、血管活性藥的使用史、IAP、APP是影響患者髮生ARF的危險因素，而IAP及APP可作為ICU患者預測ARF髮生的關鍵性指標之一，特彆是對于腎功能有異常的患者將具有重大的參攷價值。
목적：탐토불동신공능수평하복내압（ IAP）급복강관주압（ APP）대위중환자신공능적영향。방법선취2012-05～2013-09아원수치적ICU환자120례，근거환자적기출신공능분위신공능이상조70례화신공능정상조50례，채용방광측압법측량ICU환자적IAP화APP，동시채용Logistic회귀분석급성신쇠갈（ ARF）발생적상관위험인소，병근거ROC곡선구득예측ARF발생적림계IAP치、APP치。결과신공능이상조적IAP치위（17．54±5．58）mm Hg고우정상조，APP치위（65．45±11．60）mm Hg저우정상조（균P＜0．05），차신공능이상조ARF발생솔위40．28％，명현고우정상조10．00％（P＜0．01）。 Logistic회귀분석표명，환자적체위、APACHEⅡ평분、SOFA평분、혈관활성약적사용사、IAP、APP시ARF발생적독립위험인소。근거ROC곡선분석，예측ARF발생적림계IAP치、APP치분별위21．64 mm Hg화55．80 mm Hg。결론위중환자IAP급APP존재명현개체차이，체위、APACHEⅡ평분、SOFA평분、혈관활성약적사용사、IAP、APP시영향환자발생ARF적위험인소，이IAP급APP가작위ICU환자예측ARF발생적관건성지표지일，특별시대우신공능유이상적환자장구유중대적삼고개치。
Objective To discuss the effect of intra -abdominal pressure ( IAP) and abdominal perfusion pressure ( APP) in patients with different level of kidney function in ICU .Methods One hundred and twenty cases of ICU patients from May 2012 to September 2013 were selected and divided into abnormal renal function group (70 cases) and normal renal function group (50 cases) by the basis of renal function .The IAP and APP of the ICU patients were measured through monitoring the bladder pressures.At the same time, Logistic regression was used to analyze the correlative risk factors for acute renal failure ( ARF) .The IAP and APP critical value predicted ARF were obtained according to the ROC curve.Results The IAP of abnormal renal function group (17.54 ±5.58) mm Hg was higher than that of normal group;the APP of abnormal renal function group (65.45 ±11.60)mm Hg was lower than normal group; comparative differences between two groups are of statistical significance ( P <0.05).The incidence of ARF in abnormal renal function group was 40.28%, significantly higher than that in the normal group (P<0.01).Logistic regression analysis shows that body position , APACHEⅡscore, SOFA score, vascular active drug use history , IAP, APP were independent risk factors for the occurrence of ARF .According to the ROC curve analysis , the IAP and APP critical value predicted ARF were 21.64 mm Hg and 55.80 mm Hg, respectively.Conclusion The IAP and APP in ICU patients are of great individual difference .The body position , APACHEⅡ score, SOFA score, vascular active drug use history , IAP and APP are the risk factors in patients with ARF;IAP and the APP can be usedas key indicators to predict ARF occurrence in ICU patients , especially in patients with abnormal renal function.
