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目的探讨危重症患者的腹内压(IAP)、腹腔灌注压(APP)水平对肾功能及肾血流动力学的影响作用。方法选取本院重症监护病房收治的150例危重症患者,入科后对患者进行IAP、APP监测,并根据测量结果进行分组,对比各亚组患者的肾功能指标、肾血流动力学指标。结果 IAP各亚组间血肌酐(Cr)、尿素氮(BUN)比较Ⅰ级<Ⅱ级<Ⅲ级<Ⅳ级且差异具有统计学意义(P<0.05),IAPⅠ级患者的尿量显著高于Ⅱ级、Ⅲ级、Ⅳ级患者(P<0.05)。IAP各亚组间肾动脉收缩期峰流速、肾动脉舒张末期流速比较Ⅰ级>Ⅱ级>Ⅲ级>Ⅳ级且差异具有统计学意义(P<0.05),肾动脉阻力指数(RI)、搏动指数(PI)值为Ⅰ级<Ⅱ级<Ⅲ级<Ⅳ级且差异具有统计学意义(P<0.05)。APP各亚组间血肌酐(Cr)、尿素氮(BUN)、胱抑素C(Cys-c)值比较Ⅰ级<Ⅱ级<Ⅲ级且差异具有统计学意义(P<0.05),各APP亚组间尿量为Ⅰ级>Ⅱ级>Ⅲ级且差异具有统计学意义(P<0.05)。APP各亚组间肾动脉RI、PI值比较Ⅰ级<Ⅱ级<Ⅲ级且差异具有统计学意义(P<0.05),各APP亚组间肾动脉收缩期峰流速、肾动脉舒张末期流速比较为Ⅰ级>Ⅱ级>Ⅲ级且差异具有统计学意义(P<0.05)。结论危重症患者IAP、APP监测值增高与患者发生肾血流灌注降低、肾功能损害具有一定的关系。
Objective To investigate the effects of intra-abdominal pressure (IAP) and peritoneal perfusion pressure (APP) on renal function and renal hemodynamics in critically ill patients. Methods A total of 150 critically ill patients admitted to intensive care unit of our hospital were enrolled in this study. IAP and APP were monitored after the surgery. The renal function and renal hemodynamics were compared among the subgroups according to the results. Results The levels of serum creatinine (Cr) and blood urea nitrogen (BUN) in IAP subgroups were significantly lower than those in IAP patients (P <0.05). The urine output of IAP patients was significantly higher than that of IAP patients Ⅱ, Ⅲ, Ⅳ grade patients (P <0.05). The peak systolic velocity of renal artery and the end-diastolic velocity of renal artery in IAP subgroups were significantly higher than those in IAP> II> III> IV (P <0.05) The index (PI) values were Grade I Grade Ⅱ> Grade Ⅲ, and the difference was statistically significant (P <0.05). The RI and PI of renal artery in APP subgroups were compared with those of grade Ⅰ <Ⅱ <Ⅲ and the difference was statistically significant (P <0.05). The peak systolic velocity of renal artery and the velocity of terminal diastolic flow of renal artery Ⅰ grade> Ⅱ grade> Ⅲ grade and the difference was statistically significant (P <0.05). Conclusion The increase of IAP and APP in critically ill patients is related to the decrease of renal perfusion and the impairment of renal function in patients.