源于腹腔间隙综合征的急性肾功能衰竭

目的研究腹腔压力的增高对肾功能的影响。方法30例腹腔压力升高患者,男26例,女4例,平均年龄42岁±17岁。每日在同一时间检测患者腹腔压力,记录平均动脉压、中心静脉压,同时留取血液标本检测血清肌酐。结果当腹腔压力升高时,尿量由基础水平的78ml/h±26ml/h减少至31ml/h±11ml/h(P<0.01),同时血清肌酐由110mmol/L±98mmol/L增至224mmol/L±147mmol/L(P<0.01),伴随中心静脉压(由6.0mmHg±2.1mmHg至8.8mmHg±2.5mmHg,1mmHg=0.133kPa,P<0.01)和平均动脉压(由79mmHg±8mmHg至86mmHg±10mmHg,P<0.01)的升高。腹腔压力的上升与尿量呈负相关(r=-0.747,P<0.01);与血清肌酐呈正相关(r=0.816,P<0.01)。在随后的治疗中12例患者死亡,其中8例死于脓毒血症引起的多脏器功能衰竭,4例死于腹腔大出血。结论患者腹腔压力的上升与少尿、血清肌酐上升密切相关;腹腔压力降低后,上述临床结果得到改善。

Acute renal failure due to abdominal compartment syndrome

OBJECTIVE: To observe the effect of intra-abdominal hypertension on renal function. METHODS: 30 intra-abdominal hypertension patients, 26 mals and 4 femals, age 42 +/- 17, were observed. Intra-abdominal pressure, mean arterial pressure, central venous pressure and serum creatinine were recorded and tested at the same time every day. RESULTS: When the intra-abdominal pressure increased, the urine output decreased (from 78 ml/h +/- 26 ml/h to 31 ml/h +/- 11 ml/h, P < 0.01), serum creatinine increased (from 110 mmol/L +/- 98 mmol/L to 224 mmol/L +/- 147 mmol/L, P < 0.01) with high central venous pressure (6.0 mm Hg +/- 2.1 mm Hg to 8.8 mm Hg +/- 2.5 mm Hg, 1 mm Hg = 0.133 kPa, P < 0.01) and high mean arterial pressure (from 79 mm Hg +/- 8 mm Hg to 86 mm Hg +/- 10 mm Hg, P < 0.01). There is a significant negative correlation between the intra-abdominal hypertension and urine output (r = -0.747, P < 0.01), and a significant positive correlation between the intra-abdominal hypertension and serum creatinine (r = 0.816, P < 0.01). During the ICU stay, 12 patients died, amoung which 8 died from multiple organ dysfunction due to septicemia and 4 died from abdominal hemorrhage. CONCLUSION: Intra-abdominal hypertension is correlated with lower urine output and increased blood creatinine significantly, and these results can be inversed when the intra-abdominal pressure decreases.