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腹内高压持续时间强烈预测重症外科患者的预后：一项前瞻性观察性研究。

The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study.

作者信息

Kyoung Kyu-Hyouck, Hong Suk-Kyung

机构信息

Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, Republic of Korea.

Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, Republic of Korea.

出版信息

World J Emerg Surg. 2015 May 30;10:22. doi: 10.1186/s13017-015-0016-7. eCollection 2015.

DOI:10.1186/s13017-015-0016-7
PMID:26056530
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4459464/
Abstract

INTRODUCTION

Intra-abdominal hypertension (IAH) is associated with morbidity and mortality in critically ill patients. The present study analyzed the clinical significance of IAH in surgical patients with severe sepsis.

METHODS

This was a prospective study carried out in the surgical intensive care unit (SICU). Intra-abdominal pressure (IAP) was measured three times a day via a urinary catheter filled with 25 mL of saline. IAH was defined as an IAP ≥ 12 mmHg, and the peak IAP was recorded as the IAP for the day. Data were analyzed in terms of IAH development and the IAH duration.

RESULTS

Of the 46 patients enrolled in the study, 42 developed IAH while in the SICU. The development of IAH aggravated the clinical outcomes; such as longer SICU stay, requirement of ventilator support, and delayed initiation of enteral feeding (EF). The IAH duration showed a significant correlation with pulmonary, renal, and cardiovascular function, and enteral feeding. The IAH duration was an independent predictor of 60-day mortality (odds ratio: 1.196; p = 0.014).

CONCLUSIONS

The duration of IAH is a more important prognostic factor than the development of IAH; thus every effort should be made to reduce the IAH duration in critically ill patients.

TRIAL REGISTRATION

NCT01784458.

摘要

引言

腹内高压（IAH）与危重症患者的发病率和死亡率相关。本研究分析了IAH在重症脓毒症外科患者中的临床意义。

方法

这是一项在外科重症监护病房（SICU）开展的前瞻性研究。通过向导尿管内注入25 mL生理盐水，每天测量3次腹内压（IAP）。IAH定义为IAP≥12 mmHg，记录每日的最高IAP作为当日腹内压。依据IAH的发生情况和持续时间对数据进行分析。

结果

本研究纳入的46例患者中，42例在SICU期间发生了IAH。IAH的发生使临床结局恶化，如在SICU停留时间延长、需要呼吸机支持以及肠内营养（EF）启动延迟。IAH持续时间与肺、肾和心血管功能以及肠内营养显著相关。IAH持续时间是60天死亡率的独立预测因素（比值比：1.196；p = 0.014）。

结论

IAH的持续时间比IAH的发生是更重要的预后因素；因此应尽一切努力缩短危重症患者的IAH持续时间。

试验注册

NCT01784458。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e2f/4459464/e827a069e88a/13017_2015_16_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e2f/4459464/1d5fd3138b3d/13017_2015_16_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e2f/4459464/e827a069e88a/13017_2015_16_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e2f/4459464/1d5fd3138b3d/13017_2015_16_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e2f/4459464/e827a069e88a/13017_2015_16_Fig2_HTML.jpg

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