计算机断层扫描特征预测急性坏死性胰腺炎的腹腔内高压：一项前瞻性研究。
Computed tomography features predictive of intra-abdominal hypertension in acute necrotizing pancreatitis: A prospective study.
机构信息
Departments of Gastroenterology, and Radiodiagnosis, Post Graduate Institute of Medical Education and Research , Sector 12, Chandigarh, 160 012, India.
Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research , Sector 12, Chandigarh, 160 012, India.
出版信息
Indian J Gastroenterol. 2021 Jun;40(3):326-332. doi: 10.1007/s12664-021-01149-9. Epub 2021 May 21.
BACKGROUND
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in acute pancreatitis (AP) are associated with development and worsening of organ failures and poor prognosis. Limited studies suggest that contrast-enhanced computed tomography (CECT) can predict the presence of IAH/ACS. We aimed to study clinical profile of patients with AP and IAH and identify predictive factors of IAH on CECT abdomen.
METHODS
Consecutive patients admitted with moderately severe and severe acute pancreatitis (SAP) were recruited. Clinical and radiological data were recorded prospectively. Intra-abdominal pressure was measured via a urinary catheter to document the presence of IAH/ACS. CECT abdomen was done within the first week of admission and various features that may predict the presence of IAH were studied.
RESULTS
Thirty-seven patients (24 SAP) (mean age: 39.78 ± 13.43 years and 67.6% males) with AP were studied. The most common etiology was alcohol (37.7%). IAH developed in 54.05% of patients; patients with IAH had significantly higher bedside index of severity in AP (BISAP), Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score, persistent acute lung injury (ALI), persistent acute kidney injury (AKI), persistent cardiovascular failure (CVSF), intensive care unit (ICU) stay, and mortality. Among the CT predictors, patients with IAH more commonly had moderate-gross ascites (60% vs. 23.5%, p-value - 0.026), a pancreatic necrosis of > 50% (50% vs. 17.6%, p-value - 0.04), and a round belly sign (RBS) (50% vs. 5.9%, p-value 0.03). On multivariate analysis, only RBS was predictive of IAH (odds ratio 12.6, 95% confidence interval 1.3-124.2, p-value 0.03). The sensitivity, specificity, positive predictive value, and negative predictive value for RBS were 50%, 94.12%, 90.9%, and 61.54%, respectively.
CONCLUSION
Presence of RBS, moderate-gross ascites, and pancreatic necrosis of > 50% on CECT can predict the presence of IAH in these groups of patients.
背景
急性胰腺炎（AP）中的腹腔内高压（IAH）和腹腔间隔室综合征（ACS）与器官衰竭的发展和恶化以及不良预后有关。有限的研究表明，增强 CT（CECT）可以预测 IAH/ACS 的存在。我们旨在研究患有 AP 和 IAH 的患者的临床特征，并确定 CECT 腹部的 IAH 预测因素。
方法
连续招募患有中度和重度急性胰腺炎（SAP）的患者。前瞻性记录临床和影像学数据。通过导尿管测量腹腔内压以记录 IAH/ACS 的存在。在入院后的第一周内进行 CECT 腹部检查，并研究可能预测 IAH 存在的各种特征。
结果
研究了 37 名（24 名 SAP）（平均年龄：39.78±13.43 岁，67.6%为男性）患有 AP 的患者。最常见的病因是酒精（37.7%）。54.05%的患者发生 IAH；患有 IAH 的患者的床边严重程度指数（BISAP）、急性生理和慢性健康评估 II（APACHE II）评分、持续性急性肺损伤（ALI）、持续性急性肾损伤（AKI）、持续性心血管衰竭（CVSF）、重症监护病房（ICU）入住率和死亡率均显著更高。在 CT 预测因素中，患有 IAH 的患者更常见中等量腹水（60%比 23.5%，p 值 -0.026）、胰腺坏死>50%（50%比 17.6%，p 值 -0.04）和圆腹征（RBS）（50%比 5.9%，p 值 0.03）。多变量分析显示，只有 RBS 可预测 IAH（优势比 12.6，95%置信区间 1.3-124.2，p 值 0.03）。RBS 的敏感性、特异性、阳性预测值和阴性预测值分别为 50%、94.12%、90.9%和 61.54%。
结论
CECT 上存在 RBS、中等量腹水和胰腺坏死>50%可预测这些患者群体中 IAH 的存在。
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