摘要
目的分析持续肾替代治疗(continuous renal replacement therapy,CRRT)对合并不同等级腹内高压的重症急性胰腺炎患者的腹内压的作用及临床意义,同时明确腹内压高低是否可作为该类患者启用CRRT治疗的指标之一。方法回顾2020年9月至2022年9月由徐州医科大学附属医院急诊ICU收治,接受CRRT治疗的符合重症急性胰腺炎诊断标准,且腹内压(intraabdominal pressure,IAP)≥12 mmHg的66例患者的临床资料。按照IAP高低分为A组:12 mmHg≤IAP<15 mmHg,22例,B组:15 mmHg≤IAP≤20 mmHg,23例,C组:IAP>20 mmHg,21例,记录三组患者的一般临床资料和行CRRT治疗前和治疗后的IAP值,以及治疗前后IAP的差值ΔIAP,对比分析三组患者的一般临床资料,同时以独立样本t检验比较分析治疗前后IAP的差别以及BC两组ΔIAP的差别,并通过spearman相关性检验,分析治疗前IAP和ΔIAP的关系。结果治疗前三组患者的性别、年龄、修正马歇尔评分、APACHEⅡ评分、机械通气数、病因等方面差异无统计学意义(P>0.05),行CRRT治疗后,A组患者治疗前后IAP变化不明显(P>0.05),B组和C组患者治疗后IAP较治疗前显著下降(P<0.05),且C组的ΔIAP要明显大于B组的ΔIAP(P<0.05)。B组与C组患者治疗前IAP与ΔIAP存在正相关性(P<0.05)。结论⑴对于合并腹内高压的重症胰腺炎患者,当IAP≥15 mmHg时行CRRT治疗可有效降低IAP,并且IAP越高则CRRT控制腹内压的效果越明显。⑵IAP≥15 mmHg可作为重症急性胰腺炎患者启用CRRT治疗的指标之一。
Objective To analyze the effect and clinical significance of continuous renal replacement therapy(CRRT)on severe acute pancreatitis complicated with different grades of intraabdominal hypertension,and to determine whether the level of intra-abdominal pressure can be used as one of the indicators of CRRT in these patients.Methods From September 2020 to September 2022,the clinical data of 66 patients with severe acute pancreatitis complicated by intra-abdominal pressure(IAP)≥12 mmHg who were treated with CRRT and admitted to the EICU of Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.According to the level of IAP,they were divided into group A:12 mmHg≤IAP<15 mmHg,22 cases;group B:15 mmHg≤IAP≤20 mmHg,23 cases and group C:IAP>20 mmHg,21 cases.The general clinical data and IAP values before and after CRRT treatment,as well as theΔIAP(difference of IAP before and after treatment)were recorded.The difference of IAP before and after treatment and theΔIAP between group B and group C were compared by independent sample t test.The relationship between IAP before treatment andΔIAP was analyzed by spearman test.Results There were no significant differences in gender,age,modified Marshall score,APACHEⅡscore,number of mechanical ventilation,and etiology among the three groups before treatment(P>0.05).After CRRT treatment,IAP of group A was no significantly changed before and after treatment(P>0.05).IAP in groups B and C was significantly lower after treatment than before treatment(P<0.05),and theΔIAP of group C was significantly higher than that of group B(P<0.05).There was a positive correlation between IAP before treatment andΔIAP in group B and Group C(P<0.05).Conclusions 1.For patients with severe pancreatitis complicated with intra-abdominal hypertension,CRRT treatment can effectively reduce IAP when IAP≥15 mmHg,and the higher the IAP,the more obvious effect of CRRT treatment in controlling intra-abdominal pressure.2.IAP≥15 mmHg can be used as one of the indicators for CRRT
作者
杭轶
朱军
叶英
丁伟超
康洁
Hang Yi;Zhu Jun;Ye Ying;Ding Weichao;Kang Jie(Department of Emergency Medicine,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Emergency Critical Care Medicine,Xuzhou Medical University Affiliated Hospital,Xuzhou 221000,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2023年第11期1501-1505,共5页
Chinese Journal of Emergency Medicine
关键词
重症急性胰腺炎
持续肾替代治疗
腹内压
腹内高压
severe acute pancreatitis
Continuous renal replacement therapy
Intra-abdominal pressure
Intra-abdominal hypertension
