腹腔内压监测在机械通气患者中的临床意义探讨

目的：探讨腹腔内压（IAP）监测在机械通气患者中的应用和临床意义。方法采用前瞻性研究方法，以膀胱测压法检测重症医学科接受呼吸机治疗的危重住院患者的IAP，对于存在腹腔内高压（IAH）和腹腔间隔室综合症（ACS）患者按照标准流程进行系统管理。并根据其IAP值以及预后分为腹腔高压组（IAH组）、非IAH组、生存组和死亡组，分别比较各组患者平均动脉压（MAP）、IAP、腹腔灌注压（APP）以及血肌酐（Cr）等指标。结果共监测102例患者，其中30例（29.41%）发生IAH，4例（3.92%）发生ACS，死亡14例（13.73%）；IAH组IAP、Cr显著高于非IAH组（IAP：15.12±2.78 mmHg比8.09±2.63 mmHg；Cr：133.48±88.69μmol/L比74.37±35.60μmol/L；P＜0.05），MAP与APP差异无统计学意义；死亡组APP显著低于生存组（60.76±14.89 mmHg比72.51±15.76 mmHg；P＜0.05），Cr则显著高于生存组（142.56±78.43μmol/L比85.66±43.72μmol/L；P＜0.05），MAP、IAP差异无统计学意义。结论对接受机械通气治疗的危重患者常规监测IAP可以早期发现和干预IAH，改善脏器功能以及患者预后，具有重要临床意义。

The Monitoring of Intra-Abdominal Pressure in Critically Ill Patients with Mechanical Ventilation

Objective To study the clinical significance of monitoring intra-abdominal pressure （IAP） in critically ill patients with mechanical ventilation.Methods A prospective study was conducted. IAP of all the patients with mechanical ventilation in ICU was measured through the bladder technique. The patients with intra-abdominal hypertension （IAH） or abdominal compartment syndrome （ACS） were given appropriate treatment and management for IAH and/or ACS. Mean arterial pressure （MAP）, IAP, abdominal perfusion pressure （APP）, and serum creatinine （Cr） were determined in patients with or without IAH, as well as in survivors and non-survivors. Results The entire protocol of IAP measurement was completed in 102 patients. Number of IAH and ACS patients was 30 （29.41%） and 4 （3.92%） respectively. Finally 14 （13.73%） patients died. Compared with non-IAH patients, IAP and Cr were increased in IAH patients （IAP： 15.12±2.78 mmHg vs 8.09±2.63 mmHg; Cr： 133.48±88.69μmol/L vs 74.37±35.60μmol/L;P〈0.05）. There were no signifi cant differences in MAP and APP between IAH group and non-IAH group. Compared with survivors, non-survivors showed significantly lower APP （ 60.76±14.89 mmHg vs 72.51±15.76 mmHg;P〈0.05）, and higher Cr （142.56±78.43μmol/L vs 85.66±43.72μmol/L;P〈0.05）. There were no signifi cant differences in MAP and IAP between survivors and non-survivors.Conclusion Earlier IAP measurements in critically ill patients with mechanical ventilation are essential for the detection and treatment of IAH/ACS, and can improve the function of organs and the prognosis of the patients.