| 余静喜,谷欣.腹内压改变在重症急性胰腺炎伴肠屏障功能障碍患者中的临床意义[J].安徽医药,2016,20(10):1885-1888. |
| 腹内压改变在重症急性胰腺炎伴肠屏障功能障碍患者中的临床意义 |
| Clinical significance of changes in IAP in evaluation for the condition and prognosis of IAH patients |
| 投稿时间：2016-02-24 |
| DOI： |
| 中文关键词: 腹内压 重症急性胰腺炎 肠屏障功能障碍 APACHE Ⅱ评分 |
| 英文关键词: Intra-abdominal pressure Severe acute pancreatitis Intestinal barrier dysfunction APACHE Ⅱ score |
| 基金项目:广东省卫生厅科学技术项目(WSTJJ20111224430202198008144077)腹内压改变在重症急性胰腺炎伴肠屏障功能障碍患者中的临床意义余静喜a,谷欣b (惠州市第三人民医院,a.普外科,b.ICU,广东 惠州 516000)腹内压改变在重症急性胰腺炎伴肠屏障功能障碍患者中的临床意义余静喜,谷欣 |
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| 中文摘要: |
| 目的 研究腹内压与重症急性胰腺炎伴肠屏障功能障碍相关性,探讨腹内压变化对重症急性胰腺炎伴肠屏障功能障碍患者病情与预后的评价价值。方法 选择重症急性胰腺炎伴肠屏障功能障碍患者60例,其中将腹内压≤12 mmH2O的13例患者设为无腹内高压组,将腹内压＞12 mmH2O的32例患者设为腹内高压组,将腹内压≥20 mmH2O 并且伴发新的器官功能衰竭患者15例设为腹腔间隔室综合征组；运用膀胱测压法对其腹内压进行监测,探讨腹内压与肠屏障功能障碍的相关性,观察接受手术治疗的患者在术前及术后腹内压与肠屏障功能障碍标志物血清内毒素与尿 L/M 比值之间的变化,计算腹内压变异率、急性生理与慢性健康评分Ⅱ(APACHE Ⅱ)与Ranson评分相关性及其对病死率的预测价值。结果 无腹内高压组、腹内高压组与腹腔间隔室综合征组的肠屏障功能障碍标志物内毒素与尿 L/M 比较差异有统计学意义(P＜0.05),其中以腹腔间隔室综合征组最高,无腹内高压组最低。经相关性比较,腹内压和内毒素(r=0.225,P=0.032)和尿 L/M比较,差异有统计学意义(r=0.187,P=0.046)。与术前比较,本组36例行手术治疗的患者中存活的33例患者术后的第3天患者的腹内压、内毒素与尿 L/M均明显减少(P＜0.05)。采用Pearson相关性分析,腹内压变异率和APACHE Ⅱ、Ranson评分呈显著正相关(P＜0.05),APACHE Ⅱ、Ranson评分呈显著正相关(P＜0.05)。腹内压变异率对患者病死率预测值,即ROC曲线下面积达93.58%,略高于APACHE Ⅱ评分ROC曲线下面积89.58%,两者比较差异无统计学意义(P＞0.05),但与Ranson评分ROC曲线下面积82.32%比较差异有统计学意义(P＜0.05)。结论 重症急性胰腺炎伴肠屏障功能障碍能够引发腹内高压与腹腔间隔室综合征,而腹内高压与腹腔间隔室综合征也会促进肠屏障功能发生损伤。腹内压变化能够反映出重症急性胰腺炎伴肠屏障功能障碍患者病情程度及预后情况,有助于尽早实施干预治疗。 |
| 英文摘要: |
| Objective To explore the value of the change rate of IAP in evaluation for the condition and prognosis in IAH patients.Methods Sixty cases of severe acute pancreatitis complicated with intestinal barrier dysfunction admitted to The Third Hospital of Huizhou,Guangdong were retrospectively analyzed.They were assigned into three groups:the no intra-abdominal hypertension group (n=13),intra-abdominal hypertension group (n=32) and abdominal compartment syndrome group (n=15),All cases were given bladder manometry for intra-abdominal pressure monitoring,The relationship between intra-abdominal pressure and intestinal barrier dysfunction was explored,and changes in intra-abdominal pressure,intestinal barrier dysfunction sign serum endotoxin and urinary L/M ratio in patients before and after the surgery,Intra-abdominal pressure variation rate,APACHE Ⅱ and ranson score correlation and its predictive value for mortality were calculated.Results There were significant differences in intestinal barrier dysfunction signs serum endotoxin and urinary L/M ratio among three groups (P＜0.05),with the highest in the abdominal compartment syndrome group and the lowest in no abdominal hypertension group,Correlation comparison results indicated that the differences in intra-abdominal pressure and endotoxin (r=0.225,P=0.032) and urine lactulose mannitol (r=0.187,P=0.046) were significantly and positively correlated,Three days after surgery the intra-abdominal pressure,endotoxin and urine L/M were significantly reduced in 33 survivals among 36 patients who underwent surgery compared with preoperation (P<0.05),The pearson correlation analysis revealed that intra-abdominal pressure variation rate was significantly and positively related to APACHE Ⅱ score and ranson score (P<0.05);APACHE Ⅱ was significantly and positively related to ranson score(P<0.05),Through intra-abdominal pressure variation rate predictive value for mortality(area under the ROC curve)was 93.58%,slightly higher than 89.58% through APACHE Ⅱ score,which showed no statistically significant difference,however,ranson score′s predictive value was 82.32%,which was significantly different from those of intra-abdominal pressure variation rate and ranson score(P<0.05).Conclusions Change rate of IAP can effectively reflect the condition and prognosis of IAH patients,which is expected to provide theoretical basis for early intervention of IAH patients. |
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