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目的:探讨严重创伤后腹内高压(intra-abdominal hypertension,IAH)与急性肾功能衰竭(ARF)的关系。方法:回顾分析60例严重创伤患者的临床相关资料,确定ARF的诊断标准;采用膀胱内压检测法间接测量腹内压,伤后前3d内每天腹内压超过20mmHg者为IAH,比较IAH组与非IAH组在伤后3d的腹内压值和血清肌酐、尿素氮水平及肾小球滤过梯度、每小时尿量以及平均动脉压的变化。采用多元相关性分析严重创伤后ARF发生的相关危险因素。结果:IAH组27例患者中,12例(44.4%)发生ARF,伤后前3d肾小球滤过梯度显著降低,血清肌酐和尿素氮的水平显著升高,每小时尿量显著减少;非IAH组33例患者中,仅有3例(9.1%)发生ARF,两组比较,差异有统计学意义(P<0.05)。多元相关性分析提示,患者年龄≥60岁、伤后平均动脉压(MAP)降低、伤后IAH等与严重创伤后ARF的发生明显相关。结论:IAH是ARF发生的高度危险因素;严密监测伤后腹内压的变化,对预防与减轻ARF具有较重要的临床意义。
Objective: To investigate the relationship between intra-abdominal hypertension (IAH) and acute renal failure (ARF) after severe trauma. Methods: The clinical data of 60 patients with severe trauma were retrospectively analyzed to determine the diagnostic criteria of ARF. The intra-abdominal pressure was measured indirectly by intravesical pressure test. The patients with IAH more than 20mmHg every day before the first post-injury were IAH. Intra-abdominal pressure and serum creatinine, urea nitrogen levels and glomerular filtration gradient, hourly urine output and mean arterial pressure were compared with non-IAH group at 3d post injury. Multivariate correlation analysis was used to analyze the related risk factors of ARF after severe trauma. Results: ARF occurred in 12 patients (44.4%) in 27 patients in IAH group, glomerular filtration rate decreased significantly before injury, serum creatinine and urea nitrogen levels increased significantly, urine output decreased significantly every hour; In 33 cases of IAH group, only 3 cases (9.1%) had ARF. The difference between the two groups was statistically significant (P <0.05). Multivariate correlation analysis showed that patients aged ≥ 60 years, mean arterial pressure (MAP) decreased after injury, IAH and other post-traumatic ARF significantly correlated. Conclusion: IAH is a high risk factor for ARF. To monitor the changes of intra-abdominal pressure closely is of great clinical significance in preventing and reducing ARF.