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目的:探讨腹内高压(IAH)与急性胰腺炎(AP)病情严重程度的相关性。方法:选取2014年2月—2015年2月收治的AP患者80例,根据入院APACHE II评分,其中轻症胰腺炎(MAP)49例(MAP组),重症胰腺炎(SAP)31例(SAP组)。采用经膀胱间接测量法监测腹内压(IAP),4 h/次,连续5 d,连续2次IAP值≥12 mm Hg诊断为IAH。比较两组IAH发生率,分析IAP值与APACHE II评分的相关性;比较SAP患者中发生IAH与未发生IAH患者不良临床事件的发生率,采用ROC曲线(AUC)评价APACHE II评分和IAP值预测SAP患者不良临床事件的价值。结果:SAP组IAH发生率明显高于MAP组(45.2%vs.0%,P<0.05);Pearson相关分析结果显示,IAP值与APACHE II评分呈正相关(r=0.752,P<0.05);SAP患者中,发生IAH者各项不良临床事件发生率均明显高于未发生IAH者(P<0.05);IAP值预测SAP患者不良临床事件的AUC明显大于APACHE II评分(0.892 vs.0.610,P<0.05)。结论:IAH与AP病情严重程度密切相关,并影响AP患者的临床结局。IAP在预测SAP患者不良临床事件发生风险的方面具有重要的临床价值。
Objective: To investigate the correlation between the severity of intra-abdominal hypertension (IAH) and acute pancreatitis (AP). Methods: Eighty AP patients admitted from February 2014 to February 2015 were enrolled in this study. According to the admission APACHE II score, 49 patients with mild pancreatitis (MAP), 31 with severe pancreatitis (SAP) group). Indirect intravesical instillation was used to detect intra-abdominal pressure (IAP) for 4 h / time for 5 consecutive days. Two consecutive IAPs ≥ 12 mm Hg were diagnosed as IAH. The incidence of IAH was compared between two groups to analyze the correlation between IAP value and APACHE II score. The incidence of adverse clinical events in patients with and without IAH was compared. The ROC curve (AUC) was used to evaluate APACHE II score and IAP value The value of adverse clinical events in SAP patients. Results: The incidence of IAH in SAP group was significantly higher than that in MAP group (45.2% vs.0%, P <0.05). Pearson correlation analysis showed that IAP was positively correlated with APACHE II score (r = 0.752, P <0.05) The incidence of adverse clinical events in patients with IAH were significantly higher than those without IAH (P <0.05). The AUC of IAP in predicting adverse clinical events in patients with SAP was significantly higher than that in patients with APACHE II (0.892 vs.0.610, P < 0.05). Conclusion: IAH is closely related to the severity of AP and affects the clinical outcome of AP patients. IAP has important clinical value in predicting the risk of adverse clinical events in SAP patients.