Keskinen Paivi, Leppaniemi Ari, Pettila Ville, Piilonen Anneli, Kemppainen Esko, Hynninen Marja
Department of Anesthesiology and Intensive Care Medicine, Meilahti Hospital, Helsinki University Central Hospital, PO Box 340, 00029 HUS, Helsinki, Finland.
World J Emerg Surg. 2007 Jan 17;2:2. doi: 10.1186/1749-7922-2-2.
Hospital mortality in patients with severe acute pancreatitis (SAP) remains high. Some of these patients develop increased intra-abdominal pressure (IAP) which may contribute to organ dysfunction. The aims of this study were to evaluate the frequency of increased IAP in patients with SAP and to assess the development of organ dysfunction and factors associated with high IAP.
During 2001-2003 a total of 59 patients with severe acute pancreatitis were treated in the intensive care unit (ICU) of Helsinki University Hospital. IAP was measured by the intravesical route in 37 patients with SAP. Data from these patients were retrospectively reviewed.
Maximal IAP, APACHE II score, maximal SOFA score, maximal creatinine, age and maximal lactate were significantly higher in nonsurvivors. There was a significant correlation of the maximal IAP with the maximal SOFA, APACHE II, maximal creatinine, maximal lactate, base deficit and ICU length of stay. Patients were divided into quartiles according to the maximal IAP. Maximal IAP was 7-14, 15-18, 19-24 and 25-33 mmHg and the hospital mortality rate 10%, 12.5%, 22.2% and 50% in groups 1-4, respectively. A statistically significant difference was seen in the maximal SOFA, ICU length of stay, maximal creatinine and lactate values. The mean ICU-free days in groups 1-4 were 45.7, 38.8, 32.0 and 27.5 days, respectively. The difference between groups 1 and 4 was statistically significant.
In patients with SAP, increased IAP is associated with development of early organ failure reflected in increased mortality and fewer ICU-free days. Frequent measurement of IAP during intensive care is important in optimizing abdominal perfusion pressure and recognizing patients potentially benefitting from decompressive laparotomy.
重症急性胰腺炎（SAP）患者的医院死亡率仍然很高。其中一些患者出现腹腔内压力（IAP）升高，这可能导致器官功能障碍。本研究的目的是评估SAP患者IAP升高的频率，并评估器官功能障碍的发展以及与高IAP相关的因素。
2001年至2003年期间，共有59例重症急性胰腺炎患者在赫尔辛基大学医院重症监护病房（ICU）接受治疗。通过膀胱内途径对37例SAP患者测量IAP。对这些患者的数据进行回顾性分析。
非存活者的最大IAP、急性生理与慢性健康状况评分系统II（APACHE II）评分、最大序贯器官衰竭评估（SOFA）评分、最大肌酐值、年龄和最大乳酸值显著更高。最大IAP与最大SOFA、APACHE II、最大肌酐、最大乳酸、碱缺失及ICU住院时间显著相关。根据最大IAP将患者分为四分位数。1-4组的最大IAP分别为7-14、15-18、19-24和25-33 mmHg，医院死亡率分别为10%、12.5%、22.2%和50%。最大SOFA、ICU住院时间、最大肌酐和乳酸值存在统计学显著差异。1-4组的平均无ICU天数分别为45.7、38.8、32.0和27.5天。1组和4组之间的差异具有统计学显著性。
在SAP患者中，IAP升高与早期器官衰竭的发生相关，表现为死亡率增加和无ICU天数减少。在重症监护期间频繁测量IAP对于优化腹腔灌注压力和识别可能从减压剖腹手术中获益的患者很重要。
