特重度烧伤合并腹腔内高压对呼吸功能变化的相关性研究

目的观察特重度烧伤患者腹腔压力增高对呼吸功能的影响。方法选择16例特重度烧伤患者,根据腹内压(intra-abdominal pressure,IAP)的测量值分为两组:IAP≥12 mmHg者为腹内高压组,共10例;IAP<12 mmHg者为对照组,共6例。每日在固定时间检测患者腹腔压力一次,记录呼吸频率(RR)、动脉氧分压(PaO2)、二氧化碳分压(PaCO2)、给氧浓度(FiO2)、氧合指数(PaO2/FiO2)、平均气道压(MAP)、呼气末正压(PEEP)等指标的变化。结果腹内高压组RR、PaCO2的变化与IAP的改变呈正相关,而PaO2、PaO2/FiO2与IAP呈负相关(P<0.05),MAP、PEEP与IAP无明显相关性(P>0.05)。结论腹腔压力的上升与呼吸功能的指标具有相关性。对具有腹内高压危险因素的特重度烧伤患者应常规监测腹内压的变化,采取及时有效的治疗措施,以预防腹腔内高压及腹腔间隔室综合征的发生与发展。

Study on the Correlation between the Changes of Intra-abdominal Hypertension and Respiratory Function for Patients with Extraordinarily Severe Burn

Objective To study the effect oi respiratory iunction due to increase of intra-abdommal pres- sure （IAP） by observing extraordinarily severe burn patients. Methods A total of 16 extraordinarily severe burn patients were selected and divided into test and control groups according to IAP values. Ten patients with IAP≥12 mmHg were in high abdominal pressure group as test group. While 6 patients with IAP 〈 12 mmHg were in control group. Then the changes of respiratory rate（ RR）, oxygen partial pressure（ PaO2 ）, partial pres- sure of carbon dioxide（ PaCO2 ）, fraction of inspiration 02 （ FiO2 ）, oxygenation index（ PaO2/FiO2 ）, mean air- way pressure（MAP） and positive end-expiratory pressure（PEEP） of both two groups were monitored once per day. Result In test group, there was a positive correlation between the changes of IAP and RR, PaCO2, a negative correlation between PaO2, PaO2/FiO2 and IAP（ P 〈 O. 05 ）, and no correlation between MAP, PEEP and lAP changes （P 〉 O. 05 ）. Conclusions It showed that the changes of lAP of patients were related to their breath function indexes. For those extraordinarily severe burn patients with risk factors of high IAP should monitor their abdominal pressure changes as routine. Effective treatment for them in time could prevent intra-ab- dominal hypertension and abdominal compartment syndrome from either hapDeninz or develo,ment.