腹内压变化率对评估腹腔内高压症患者病情及预后的价值

目的：探讨腹内压变化率在评价腹腔内高压症（ intra-abdominal hypertension ，IAH）患者病情及预后的价值。方法采用经膀胱测压法监测85例IAH患者腹内压（intra-abdominal pressure，IAP），将（第3天平均腹内压-第1天平均腹内压）／第1天平均腹内压＆#215;100％的值定为腹内压变化率。检测患者血清C反应蛋白（ CRP）水平，并计算急性生理及慢性健康状况评分系统评分（ acute physiology and chronic health evaluation Ⅱ，APACHEⅡ）及病死率。结果入住重症监护病房（ ICU）第1天时，腹内压变化率≤50％与＞50％的患者APACHE Ⅱ评分及CRP水平比较无显著性差异（P＞0．05），而在第3天时，腹内压变化率≤50％患者APACHE Ⅱ评分及CRP水平分别为（23．83＆#177;5．71）分和（197．01＆#177;32．05）mg／L，均显著低于腹内压变化率＞50％的患者（35．29＆#177;6．28）分和（346．35＆#177;60．18）mg／L]，差异均有统计学意义（P＜0．05）。腹内压变化率与第3天APACHE Ⅱ评分及CRP水平呈显著正相关（APACHE Ⅱ：r＝0．714，P＜0．01；CRP：r＝0．835，P＜0．01）。腹内压变化率在死亡组与存活组间存在显著差异（P＜0．01）。经ROC曲线分析，腹内压变异率对于预测患者死亡率有意义（AUC＝0．830，P＜0．01）。结论腹内压变化率可反映IAH患者的病情和预后，有望为IAH患者的早期干预治疗提供依据。

The value of the rate of intra-abdominal pressure in evaluating for the condition and prognosis of IAH patients

Objective To explore the value of the change rate of IAP in evaluating for the condition and prognosis in IAH pa -tients.Methods IAP was indirectly measured by urinary bladder pressure for 85 IAH patients,and the value of （3 day average IAP-1 day average IAP ）/1 day average IAP ＆#215;100%] was regarded as change rate of IAP .The serum CRP level was detected ,and the A-PACHE II,SOFA score and mortality were calculated .Results On the first day of ICU ,the APACHEⅡscore and serum CRP level of patients of change rate of IAP≤50% and 〉50% were similar （P〉0.05）.But on the third day,the APACHE Ⅱ score and serum CRP level were （23.83 ±5.71） points and （197.01 ±32.05） mg/L in ≤50% group respectively,and （35.29 ±6.28） points and （346.35 ±60.18） mg/L in 〉50%group respectively.There were significant difference between the two groups （P〈0.05）.And the change rate of intra-abdominal pressure was significantly positively related to the 3 d APACHE Ⅱ score and c-reactive protein （ A-PACHE Ⅱ：r=0.714,P〈0.01;CRP：r=0.835,P〈0.01）.There were significant differences in change rate of intra-abdominal pres-sure between the death group and alive group （P〈0.01）.Analysis of the ROC curve showed that there was a significant meaning of the change rate of intra-abdominal pressure for diagnosis of mortality （AUC=0.830,P〈0.01）.Conclusion Change rate of IAP can ef-fectively reflect the condition and prognosis of IAH patients ,and is expected to provide theoretical basis for IAH patients early interven-tion treatment .