腹内压在严重腹腔感染患者病程进展中的相关研究

目的:探讨外科严重腹腔感染患者腹内压与肠屏障功能以及患者预后的相互关系。方法:对41例严重腹腔感染的外科ICU患者,分别和预后分组,观察APACHEⅡ评分、器官功能损害数目、尿L/M、内毒素水平以及病死率等相关指标。结果:按腹内压分组,高压组的APACHEⅡ评分、器官损害数目、尿L/M值、内毒素水平及病死率均高于低压组;按预后分组,治愈组和好转组的APACHEⅡ评分均随治疗下降,死亡组的APACHEⅡ评分先下降后,治疗后7d有反向升高趋势,治愈组和好转组的腹内压随治疗呈下降趋势,而死亡组在治疗后7d显著升高,治愈组和好转组的L/M、内毒素水平在治疗后第7天均有下降,死亡组则显著升高。结论:在外科危重病中,腹内压在病程进展中起到重要作用,并与肠屏障功能、内毒素血症密切相关,在疾病发展与治疗进程中,腹内压居高不下,甚至升高,以及内毒素水平、尿L/M的进行性升高均是判断预后不良的重要指标。

Study of intra-abdominal pressure on course development of patients with severe peritoneal cavity infection

Objective To investigate the interrelationship between intra-abdominal pressure,intestinal barrier function and prognosis in patients with severe peritoneal cavity infection.Method Forty-one patients with severe peritoneal cavity infection in surgery ICU were divide into groups by prognosis,and the related indexes such as APACHEⅡ score,organ function injury number,urine L/M,levels of endotoxin and fatality rate were observed.Results Divided by intra-abdominal pressure,the APACHEⅡ score,organ function injury number,urine L/M,levels of endotoxin and fatality rate of high pressure group were all higher than that of low pressure group.Divided by prognosis,the APACHEⅡscore of healing group and improving group decreased after the treatment,the APACHEⅡscore of death group decreased at first,and then showed a reversed increasing tendency after 7-day treatment;intra-abdominal pressure of healing group and improving group showed a decreasing tendency with the treatment,however the death group increased dramatically after 7-day treatment,the L/M,levels of endotoxin of healing group and improving group were all decreased after 7-day treatment,however the death group increased dramatically.Conclusion Among all the critical illnesses in surgical department,the intra-abdominal pressure plays an important role in disease progression,and it has an intimate relationship between intestinal barrier function and endotoxemia.In the progress and treatment of disease,the high or even increased intra-abdominal pressure,and the progressive increasing of the levels of endotoxin and urine L/M are all important indexes for the judgement of unfavourable prognosis.