腹腔内压力监测在危重患者预后分析中的作用

目的探讨监测腹腔内压力(IAP)在危重患者预后分析中的作用。方法采用前瞻性队列研究方法,选择我院ICU患者221例,采用经膀胱尿管间接测定方法每天监测患者IAP,连续7d。采用受试者操作特征曲线(ROC)比较各预后指标对患者预后的判断。结果存活患者IAP呈逐渐降低趋势,而死亡患者IAP则呈逐渐升高趋势,其中第5、6、7天死亡患者IAP显著高于存活患者(P<0.05或P<0.01)。Logistic多因素回归分析显示患者入ICU后第7天的IAP水平与危重患者的预后相关(OR=1.278,95%CI1.065～1.534,P=0.008)。患者入ICU第7天IAP的曲线下面积(AUC)为0.771±0.041,明显低于APACHEⅡ评分的0.921±0.021和SAPS评分的0.914±0.021(P<0.05或P<0.01)。IAP对预后的截断值为12.13mmHg,预后评价的敏感性为43.9%,特异性94.4%。结论观察IAP的变化有助于评估危重患者的预后情况。

The prognostic value of intra abdominal pressure in critically ill patients

Objective To investigate the prognostic value of intra abdominal pressure(IAP) in critically ill patients in intensive care unit(ICU).Methods This was a prospective cohort study and patients were from intensive care unit in Nanjing Gulou hospital.Intraabdominal pressure was measured twice daily via the bladder for 7 days.Receiver operating characteristic(ROC) was used to predict the prognosis.Results IAP decreased in survivors and increased in the death,especially at the 5th,6th and 7th day(P<0.05 or P<0.01).Logistic regression identified IAP at 7th day as an independent predictor of mortality(OR=1.278,95%CI 1.065-1.534,P=0.008).By using receiver operating characteristic analysis,the area under the curve was 0.771±0.041 at 7th day,however the APACHE Ⅱ score was 0.921±0.021 and SAPS score was 0.914±0.021(P<0.05 or P<0.01).The cutoff value of IAP on prognosis was 12.13 mm Hg,with the sensitivity 43.9% and specificity 94.4%.Conclusion IAP dynamics observation can be one of the factors for predicting the prognosis of critically ill patients.