恶性腹水源性腹腔间隔室综合征行早期腹腔减压治疗中患者心率、血压和呼吸变化规律的临床观察

目的 探讨恶性腹水源性腹腔间隔室综合征(MAACS)行早期置管减压治疗过程中,腹水引流量与心率、血压、呼吸变化的关系。方法 采用回顾性横断面调查,分析2012年6月—2017年6月山西大同大学附属医院肿瘤外科22例MAACS患者的临床资料。其中男13例、女9例,年龄45～74(56.44±4.46)岁。肝癌6例,胃癌2例,结肠癌1例,直肠癌2例,胰腺癌1例,胆管癌1例,卵巢癌6例,宫颈癌2例,癌性腹水未找到原发灶1例;其中合并腹腔内转移癌6例。患者均行早期腹腔减压治疗,在腹腔引流减压过程中,测量记录腹水引流前、每引流500 mL及引流完毕时腹腔压力,并同步监测患者心率、血压、呼吸的变化情况,采用简单线性回归分析腹腔引流量与心率、血压、呼吸的相关性。结果 22例患者均顺利完成腹腔置管减压治疗,腹水减压引流时间3~6(4.32±0.54)h。引流腹水量4 000～6 900(5 260±610)mL。在腹腔引流减压过程中,与腹水引流前比较:引流量≥1 500 mL时,腹腔压力下降、呼吸次数减少,差异均有统计学意义(P值均＜0.05);从流量≥1 000 mL时,各观察点心率下降,差异均有统计学意义(P值均＜0.05)。简单线性回归分析显示,随着腹腔引流量的逐渐增加,腹腔引流量与心率、呼吸有相关性(r=0.952、0.888, P值均＜0.05)。线性回归分析得回归方程为:＾Y_心率=-0.004 57 X_{腹腔引流量(mL)} + 119.0,＾Y_呼吸=-0.003 43 X_{腹腔引流量(mL)} +35.8。减压治疗后24 h内,19例心率、血压、呼吸平稳;3例出现血压下降,心率再次增加,其中2例经补液升压治疗血压、心率恢复正常,1例放弃治疗死亡。结论 早期置管减压治疗MAACS是安全的,随着腹腔引流量的增加,心率、呼吸逐渐下降,血压维持平稳,在减压后24 h内仍需密切观察心率、呼吸、血压变化情况。

Observation of the change rule of heart rate,blood pressure and respiratory changes in patients with malignant ascites water-borne abdominal compartment syndrome undergoing early catheter decompression

Objective To investigate the relationship between ascites drainage and heart rate, blood pressure and respiratory changes in patients with malignant ascites water-borne abdominal compartment syndrome (MAACS) undergoing early catheter decompression.Methods The clinical data of 22 patients with MAACS in the Department of Tumor Surgery, Affiliated Hospital of Shanxi Datong University from June 2012 to June 2017 were investigated retrospectively in cross-section. There were 13 males and 9 females, aged 45-74 (56.44 ± 4.46) years. There were 6 cases of hepatocellular carcinoma, 2 cases of gastric cancer, 1 case of colon cancer, 2 cases of rectal cancer, 1 case of pancreatic cancer, 1 case of cholangiocarcinoma, 6 cases of ovarian cancer, 2 cases of cervical cancer, and 1 case of malignant ascites, without finding the primary lesion. All patients were treated with early intraperitoneal decompression before abdominal drainage. In the process of ascites drainage, the pressure in abdominal cavity was measured before and after the drainage of ascitic fluid for every 500 mL. intra-abdominal pressure,heart rate, respiration and blood pressure were recorded synchronously. The changes of heart rate, blood pressure and respiration were observed. The correlation between abdominal drainage and heart rate, blood pressure and respiration was analyzed by linear regression.Results All the 22 patients were successfully treated by abdominal catheter decompression, and the time of drainage and drainage was 3-6 (4.32 ± 0.54) hours. The ascites volume was 4 000-6 900 (5 260 ± 610) mL. In the decompression process of abdominal drainage, the abdominal pressure decreased and the number of breathing decreased when the drainage flow was more than 1 500 mL (all P values< 0.05) comparing with that before ascites drainage. The heart rate decreased when the drainage flow was more than 1 000 mL (all P values＜0.05). Simple linear regression analysis showed that abdominal drainage was correlated with heart rate and respiration (r=0.952, 0.888, all P values＜0.05). Linear regression analysis showed:＾Y_{heart rate}=-0.004 57 X_{abdominal drainage(mL)}+119.0, ＾Y_respiration=-0.00343 X_{abdominal drainage(mL)}+35.8. Within 24 hours after decompression, heart rate, blood pressure and respiration were stable in 19 cases, decreased blood pressure in 3 cases, increased heart rate again, 2 cases were recovered by rehydration and boosting blood pressure, and 1 case gave up treatment and died.Conclusions Early catheter decompression is safe for the treatment of MAACS. With the increase of abdominal drainage, heart rate and respiration decrease gradually, and blood pressure remains stable. The changes of heart rate, respiration and blood pressure should be closely observed within 24 hours after decompression.