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目的探讨腹腔高压与急性胃肠损伤(AGI)诊断分级的关系及腹腔高压对AGI患者预后的影响。方法采用前瞻性研究方法,选取符合AGI诊断分级标准的患者124例,入组时监测膀胱压力,每4 h 1次,计算连续2次的均值,视为入组时腹腔压力(腹腔压力),腹腔压力≥12 mm Hg为腹腔高压。探讨影响AGI患者腹腔高压的相关因素、腹腔高压对AGI诊断分级的影响及影响AGI患者院内死亡因素。结果 AGI患者腹腔高压的发生率为46.77%;AGIⅠ、Ⅱ、Ⅲ、Ⅳ级分别与非腹腔高压、腹腔高压Ⅰ、Ⅱ、Ⅲ级间比较差异有统计学意义(P<0.01);腹腔高压组AGI患者年龄、机械通气率显著高于非腹腔高压组(P<0.01);AGI患者存活组与死亡组间的年龄、APACHEⅡ评分和机械通气时间差异有统计学意义(P<0.05);腹腔高压的AGI患者死亡率显著高于存活率、腹腔高压的AGI患者院内死亡率显著高于非腹腔高压者(P<0.05)。结论腹腔高压可以作为AGIⅡ级以上(包括Ⅱ级)诊断分级的重要条件,腹腔高压级别越高对AGI的诊断分级意义越大;腹腔高压是AGI患者院内死亡的重要因素,但不是独立危险因素。
Objective To investigate the relationship between abdominal hypertension and acute gastrointestinal injury (AGI) and the effect of abdominal pressure on the prognosis of patients with AGI. Methods A prospective study was conducted to select 124 patients who meet the diagnostic criteria of AGI. The pressure of bladder was monitored every 4 hours, and the mean of two consecutive times was calculated as the mean of abdominal pressure (intraperitoneal pressure) Abdominal pressure ≥ 12 mm Hg abdominal pressure. To investigate the related factors influencing abdominal pressure in patients with AGI, the effect of intra-abdominal pressure on the diagnosis and classification of AGI, and the factors affecting the in-hospital mortality in AGI patients. Results The incidence of intra-abdominal hypertension in AGI patients was 46.77%. There was significant difference in AGIⅠ, Ⅱ, Ⅲ and Ⅳ levels between non-abdominal hypertension and abdominal hypertension Ⅰ, Ⅱ and Ⅲ (P <0.01) AGI patients had significantly higher age and mechanical ventilation rate than those in non-abdominal hypertension group (P <0.01). There was significant difference in age, APACHEⅡscore and mechanical ventilation time between survivors and death patients in AGI patients (P <0.05) Of AGI patients were significantly higher than the survival rate of mortality, AGI patients with intra-abdominal high mortality was significantly higher than non-abdominal hyperparathyroidism (P <0.05). Conclusion Intraperitoneal hypertension can be used as an important condition for the diagnosis and classification of AGI level Ⅱ. The higher the level of abdominal pressure is, the more significance it will be for the diagnosis and classification of AGI. The intra-abdominal hypertension is an important factor of in-hospital death in AGI patients, but not an independent risk factor.