摘要
目的研究腹内压监测在肝移植患者中应用的临床意义。方法对2002年9月至2009年1月期间143例肝移植术后患者进行了腹内压监测。将腹内压大于10cmH2O(1cmH2O=0.098kPa)定为腹内高压组,其中10<腹内压≤15cmH2O为Ⅰ级,15<腹内压≤25cmH2O为Ⅱ级,25<腹内压≤35cmH2O为Ⅲ级,35cmH2O以上为Ⅳ级。所有病例连续7d测量腹内压并记录循环、呼吸及肾功能相关生理指标,将腹内高压组不同级别者的循环、呼吸和肾功能分别与腹内压正常组进行比较。结果肝移植术后出现腹内高压者45例(31.5%),其中Ⅰ级18例、Ⅱ级13例、Ⅲ级11例、Ⅳ级3例。腹内高压组中所有级别者的SCr和BUN与腹内压正常组比较均明显升高,而PaO2则表现为下降,差异均有统计学意义(P<0.05,P<0.01);心率只在Ⅱ、Ⅲ、Ⅳ级的腹内高压组有显著升高,呼吸频率和PaCO2只在Ⅲ、Ⅳ级的腹内高压组有显著升高,差异有统计学意义(P<0.05,P<0.01)。结论肝移植术后腹内高压并不少见,对呼吸、循环及肾功能均可造成影响,术后常规进行定期的腹内压检测是必要的,对术后实施适时适度的医疗干预具有指导作用。
Objective To investigate the clinical significance of intra-abdominal pressure measure in patients with liver transplantation by summarizing the data of 143 cases.Methods Intra-abdominal pressure was indirectly measured by urinary bladder pressure.Intra-abdominal pressure over 10 cm H2O （1 cm H2O=0.098 kPa） was regarded as intra-abdominal hypertension （IAH）,and 10〈pressure≤15 cm H2O as gradeⅠ,15〈pressure≤25 cm H2O as grade Ⅱ,25〈pressure≤35 cm H2O as grade Ⅲ,over 35 cm H2O as grade Ⅳ.The parameters of circulatory system, respiratory system, renal function and the postoperative intra-abdominal pressure for 7 days were re- corded to every patient, and the parameters of each grade IAH group were contrasted with non IAH group. Results Among 143 cases, 45 cases were IAH （31.5%）, in which 18 cases belonged to grade 1 , 13 cases belonged to gradeⅡ , 11 cases belonged to grade Ⅲ , while 3 cases belonged to grade Ⅳ. Compared with those in non-IAH group, SCr and BUN significantly increased （P〈0.05, P〈0.01）, PaO2 significantly decreased （P〈0.05, P〈0.01） in each grade IAH group; Respiratory frequency （RF）, heart rate （HR） and PaCO2 significantly increased （P〈0.05, P〈 0.01） in some grade IAH group （HR in grade Ⅱ ,Ⅲ and Ⅳ, RF and PaCO2 in grade Ⅲ and Ⅳ）. Conclusions In- tra-abdominal hypertension would affect liver function by impaired circulatory, respiratory and renal function. So, it is necessary to measure intra-abdominal pressure for patients after liver transplantation, which can help to choose appropriate treatment.
出处
《中国普外基础与临床杂志》
CAS
2009年第12期982-986,共5页
Chinese Journal of Bases and Clinics In General Surgery
基金
全军医学科学技术十一五计划课题(项目编号:06 MB153)~~
关键词
肝移植
术后
腹内压
监测
Liver transplantation
After operation
Intra-abdominal pressure
Monitoring
