体位对经膀胱内途径间接测定腹内压的影响

目的观察体位对经膀胱内途径间接测定腹内压的影响.方法按腹腔内压力(intra-abdominal pressure,IAP)分级对2011年5月—2012年1月ICU收治的12例腹内压增高患者在平卧位(0°)采用经膀胱内途径间接测定 IAP,共72例次,分别取15°、30°体位下观察IAP的变化情况.结果不同体位下IAP值比较差异有统计学意义,15°、30°体位下IAP值与平卧位IAP值相比较,差异有统计学意义(P<0.01),15°、30°体位下IAP值较0°IAP值分别增加(1.94±0.49)、(5.02±0.88)mmHg(1 mmHg=0.133 kPa),抬高体位和IAP增加呈正相关(r=0.87,P<0.01).结论抬高体位使患者IAP增加,仰卧位测量的IAP可能低估了床头抬高的患者的真实IAP,应引起重视.     

不同体位对经膀胱内途径间接测定腹内压影响的研究

目的 观察不同体位下经膀胱内途径间接测定腹内压的影响.方法 对2006～2008年本院ICU收治的48例腹内压增高的患者按IAP高低分级经膀胱间接测定腹内压.其中IAP Ⅰ级10例,IAPⅡ级18例,IAPⅢ级12例,IAPⅣ级8例.分别取平卧位、15°、30°、45°四种不同体位下观察腹内压的变化情况.结果 体位改变使患者腹内压数值发生改变,特别是45°体位时更为明显.结论 对于经膀胱内途径间接测定腹内压时要采取平卧位才使监测数据更具准确性和客观性.

Abstract：

Objective To investigate different patients'body positions influenced the intra-abdominal pressure. Methods There were 48 patients with intra-abdominal hypertension (IAH) from years of 2006 to 2008 in ICU. According to the value, the intra-abdominal pressures were ranked them four grades as four groups also: Ⅰ (10 cases), Ⅱ (18 cases), Ⅲ (12 cases), Ⅳ (8 cases). Every patient's intra-abdominal pressures were measured under 4 different body positions: prostration, elevations of 0° , 15°, 30°, 45°corresponding respective group. Results The value of intra-abdominal pressures were changed as position's variance, especially under elevations of 45 °.Conclusions In order to get precise and objective data of intra-abdominal pressure, patients'position should be prostration.     

经膀胱腹内压监测用于危重症患者的护理现状

检索相关文献,从经膀胱腹内压监测的临床意义、优点、影响因素进行了陈述,并阐述危重症患者经膀胱腹内压的监测的注意事项,为临床工作者提供理论依据.     

ICU患者经膀胱行腹内压监测时的影响因素研究进展

综述了体位、注射用生理盐水灌注量、换能器位置、机械通气以及腹带的使用等对经膀胱行腹内压监测过程的影响,提出医护人员要根据现有的循证证据进行规范的临床操作,得出精确的腹内压值,及时发现腹内高压,防止并发症。     

ICU机械通气病人经膀胱行腹内压监测影响因素的研究进展

从腹内压概念、经膀胱行腹内压监测方法、影响机械通气病人经膀胱行腹内压监测因素等方面进行综述,以期为临床提供参考。     

膀胱灌注量对重症患者经膀胱腹内压测量的影响

目的探讨重症患者膀胱灌注量对经膀胱腹内压测量的影响,寻求能反映腹内压的最佳膀胱灌注量,以指导腹腔室隔综合征的早期诊断和治疗。方法 55例有大量腹水并放置腹腔引流管的ICU患者,分别取膀胱灌注量为0、10、20、30、50ml时经膀胱腹内压,即经尿管测定的膀胱压,与用腹腔引流管直接测量的腹内压进行比较。结果膀胱灌注量为10ml时所测得的膀胱压与直接测量的腹内压比较,差异无统计学意义(t=0.216,P=0.83),相关系数r为0.953。其他灌注量下所测得的膀胱压与腹内压比较,差异均有统计学意义(P<0.001)。结论当膀胱灌注量为10ml时,膀胱压能准确反映腹内压,膀胱压与腹内压呈明显的正相关关系。     

膀胱灌注量对膀胱压和腹内压影响的临床研究

目的 探讨不同膀胱灌注量对膀胱压（IVP）和腹内压（IAP）的影响,探寻应用膀胱压间接反映腹内压的最佳膀胱灌注量,以指导腹腔室隔综合征（ACS）的早期诊断和治疗.方法 选择腹腔镜手术病人61例进行前瞻性自身对照研究.手术时,设定腹内压为15 mmHg,于膀胱灌注量为0、10、20、30、50 ml时,取腋中线髂嵴水平为零点测定膀胱压.结果 膀胱灌注量为10ml并取腋中线髂嵴水平为零点时,膀胱压与腹内压（15mmHg）最接近（P＞0.05）,为（15.08 ±0.89） mmHg.而其余灌注量所测得的膀胱压与腹内压有显著差异（P ＜0.001）.结论 当膀胱灌注量为10ml并取腋中线髂嵴水平为零点时,膀胱压能准确反映腹内压.     

小儿腹内压测量的最佳膀胱容量

成人和较大体重的患儿，已被证实向膀胱内注入50ml液体能够测出其准确的腹内压。对较小的患儿测量腹内压应注入多少液体鲜有文献报道，注入不适当的液体量能够影响腹内压的准确性，从而影响治疗干预的效果。     

危重症病人腹内压测量方法的研究进展

从腹内压测量的相关概念、腹内压测量方法、临床腹内压测量注意事项三方面进行综述,以期为医护人员临床腹内压测量方法的选择提供依据,为相关研究奠定基础。     

腹内压监测的研究进展

腹内压(intra-abdominal pressure,IAP)是指隐藏在腹腔内的压力,临床上有很多因素可以导致腹内压升高,持续腹内压升高≥12 mmHg称为腹腔高压(intra-abdominal hyperten-sion,IAH),继续升高持续>20 mmHg,伴或不伴腹腔灌注压<60 mmHg,同时合并单个或多个器官衰竭称为腹腔间室综合征(abdominal compartment syndrome,ACS),通常危及患者     

Comparison of indirect methods of measuring intra-abdominal pressure in children

Objective To determine the most accurate indirect method of measuring intra-abdominal pressure (IAP) in children.Design and setting Single-centre, prospective, clinical study in a 23-bed specialist paediatric intensive care unit in Australia.Patients and participants 20 children admitted to paediatric intensive care with a peritoneal dialysis catheter in situ following congenital cardiac surgery.Interventions IAP was measured directly via the peritoneal dialysis catheter and by intragastric manometry via an indwelling nasogastric tube, and by intravesical manometry via an indwelling transurethral urinary catheter, using volumes of 0, 1, 3 and 5 ml/kg body weight of sterile saline instilled into the bladder.Measurements and results Across the range of IAPs of 1–8 mmHg the Bland-Altman method for assessing agreement between two methods of clinical measurement showed bladder pressure measured via the urinary catheter with 1 ml/kg body weight of saline instilled to be the most accurate indirect measurement technique, tending to give pressures between 0.07 and 1.23 mmHg higher than the direct measurement (95% CI for bias). Measuring bladder pressure with either no saline instilled or more saline per kilogram body weight instilled was less accurate over the same range of pressures, as was measuring the gastric pressure.Conclusions The most accurate indirect method of measuring IAP in children over the normal range of IAPs involves measuring bladder pressure via a transurethral urinary catheter with 1 ml/kg body weight of sterile saline instilled into the bladder.     

Bedside measurement of intra-abdominal pressure (IAP) via an indwelling naso-gastric tube: Clinical validation of the technique

Objectives To compare measurements of intraabdominal pressure (IAP) via a naso-gastric tube with the previously validated technique of IAP measurement via a urinary bladder catheter. To examine an association between elevated IAP and oliguric acute renal failure.Design Simultaneous paired measurements of gastric and urinary bladder pressures in supine patients.Setting The general intensive care units of two London hospitals.Patients 141 Paired measurements of intragastric and urinary bladder pressures were obtained in 26 general intensive care patients.Measurements and results With the patient lying supine, 50 ml of sterile water were instilled via manometer tubing into the stomach and bladder following drainage of each viscera. The mid-axillary line was used as the zero reference, and cavity pressures noted in centimeters of water (cmH₂O) at end expiration. The results were compared using the technique of Bland and Altman.Results Gastric pressure may be approximately 2.5 cmH₂O above or below urinary bladder pressure. Manometric measurement of the gastric pressure via a naso-gastric tube provides a simple, reliable, non-invasive technique of IAP measurement. IAP should be regularly monitored in patients with abdominal distension at risk of acute renal failure.Presented in part at the Intensive Care Society (UK) meeting, Swansea, April 1991     

Semicontinuous intra-abdominal pressure measurement using an intragastric Compliance catheter

Objective To compare intra-abdominal pressure (IAP) measurements obtained from an intragastric Compliance catheter with the pressure measured directly in the abdominal cavity. Design and setting Prospective cohort study in an operating room of the Ghent University Hospital Patients Seven patients undergoing elective laparoscopic cholecystectomy. Interventions IAP was obtained from both an intragastric catheter and directly from the peritoneal cavity at 1-minute intervals in patients undergoing elective cholecystectomy and compared using Bland-Altman analysis. Measurements and results In 156 paired measurements obtained from 7 patients the mean difference between IAP_gastric and IAP_ref was 0.12 ±  0.70 mmHg (95% CI 0.01–0.23). Conclusions IAP measured using an intragastric Compliance catheter reliably reflects the reference IAP in patients undergoing laparoscopic cholecystectomy. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. J.J. De Waele is supported by a Clinical Doctoral Grant of the Fund for Scientific Research-Flanders (Belgium; F.W.O.-Vlaanderen).     

胰十二指肠切除术后腹腔感染的危险因素分析

目的 分析胰十二指肠切除术后腹腔感染发生的危险因素.方法 回顾性分析我院1994年1月至2008年1月101例胰十二指肠切除术患者的临床资料,分析影响腹腔感染发生的危险因素.结果 腹腔感染的发生率为12.9%(13/101);单变量分析结果 表明胰胆肠瘘、术后肺炎、术前急性胆管炎、胰腺质地是腹腔感染发生的危险因素(P<0.05),多因素Logistic回归分析结果 表明胰胆肠瘘、术后肺炎、术前急性胆管炎是腹腔感染发生的独立危险因素,相对危险度(OR)分别为11.914、9.891和7.197.结论 胰胆肠瘘、术后肺炎、术前急性胆管炎是胰十二指肠切除术后腹腔感染发生的危险因素,积极防治胰胆肠瘘、术后肺炎、术前急性胆管炎可降低腹腔感染发生率.     

Saline volume in transvesical intra-abdominal pressure measurement: enough is enough

Objective The objective was to determine the minimum volume of instillation fluid for intra-abdominal pressure (IAP) measurement, and to evaluate the effect of instillation volume on transvesically measured IAP. Design Prospective cohort study Setting Twenty-two-bed surgical ICU of the Ghent University Hospital Patients and participants Twenty patients at risk of intra-abdominal hypertension (IAH). Interventions Transvesical IAP measurement using volumes from 10 to 100 ml. Minimal volume at which an IAP was measured was recorded (IAP_min), as well as IAP at 50 and 100 ml of instillation volume (IAP₅₀ and IAP₁₀₀). The percentage difference for IAP₅₀ and IAP₁₀₀ was calculated. Measurements and results The minimal volume for IAP measurement was 10 ml in all patients. Mean IAP_min was 12.8 mmHg (± 4.9), mean IAP₅₀ 15 mmHg (± 4.5) and mean IAP₁₀₀ 17.1mmHg (± 4.7). The mean percentage difference for IAP₅₀ was 21% (± 17%), and 40% (± 29%) for IAP_100. Twelve patients were categorised as suffering from IAH when 10 ml of saline was used for IAP measurement, increasing to 15 and 17 patients respectively when using 50 and 100 ml. In patients with IAH, there was a significant correlation between the duration of bladder drainage and percentage difference for IAP₁₀₀ (Pearson correlation coefficient 0.60, p = 0.03). Conclusions Using 50 or 100 ml of saline for IAP measurement in critically ill patients results in higher IAP values compared with the use of 10 ml, and possibly, in overestimation of the incidence of intra-abdominal hypertension. This work was presented at the annual meeting of the European Society of Intensive Care Medicine, Amsterdam 10–13 October 2005     

膀胱癌经尿道肿瘤电切术患者心理弹性现况与影响因素分析

目的探讨膀胱癌经尿道膀胱肿瘤电切术患者心理弹性现况与影响因素。方法选取2018年2月至2019年5月我院收治的膀胱癌经尿道膀胱肿瘤电切术患者106例为研究对象,采用自制问卷及心理弹性量表(CD-RISC)对膀胱癌经尿道膀胱肿瘤电切术患者心理弹性现况进行调查,采用单因素分析和多因素logistic回归分析膀胱癌经尿道膀胱肿瘤电切术患者心理弹性的影响因素。结果本组患者心理弹性得分(60. 13±4. 69)分,总体处于一般水平。多因素logistic回归分析显示,文化程度、月均收入水平、社会支持及自我效能感是影响膀胱癌经尿道膀胱肿瘤电切术患者心理弹性的独立危险因素(P <0. 05)。结论膀胱癌经尿道膀胱肿瘤电切术患者心理弹性处于一般水平,因此,医护人员应针对患者情况制定护理干预措施,为患者提供合适的健康教育指导,减轻其经济压力,提高自我效能感、社会支持及心理弹性,促进其身心康复及远期预后的良性发展。     

护理专业毕业生就业压力现状及影响因素探讨

目的 调查护理专业毕业生就业压力现状并探讨其影响因素,为护理院校的教育管理、就业指导及心理干预提供依据.方法 以南阳医学高等专科学校2012届三年制普通中专、三年制普通专科的毕业生及南阳理工学院2012届四年制普通护理本科毕业生为研究对象,选取中国医科大学杜天骄编制的“医学生就业压力问卷”作为调查工具,以班为单位集体施测.采用SPSS13.0建立数据库并进行统计分析.结果 护理专业学生总的就业压力为M=3.2.压力源7个维度得分由高到低依次为:岗位需求、社会环境、家庭支持、个人素质、学校影响、专业要求、就业指导.多元回归分析发现,是否为学生干部、不同生源和学历是就业压力的影响因素.结论 研究提示,对于学历层次不同、生源不同的护理毕业生,应该给予不同的心理干预,以缓解其就业压力.     

褥疮影响因素分析及护理对策

目的 通过了解和分析影响褥疮发生的主要因素,提高护理效率,降低褥疮的发生率。 方法 应用非条件Logistic回归分析,对收集到褥疮高发人群相关数据进行单因素和多因素分析。结果 单因素分析显示,年龄、BMI、卧床时间、Braden评分、陪护人员褥疮防护知识知晓情况和康复训练6个因素均有统计学意义(P<0.05)。其中,较低Braden评分具有高度危险作用(OR=9.10);高龄,肥胖和卧床时间也是褥疮发生的危险因素(OR值分别为0.44,0.38和0.02);陪护人员褥疮知识知晓情况和参与康复训练具有保护作用(OR值分别为0.13和0.14)。多因素分析显示,影响褥疮发生的主要因素包括：康复训练、Braden评分、年龄和BMI4个因素,其中康复训练的具有较高保护作用。 结论 褥疮发生的主要影响因素是Braden评分和康复训练,加强对高龄和肥胖等高发人群的护理能有效减低褥疮的总体发生率。