持续性血液净化治疗对腹腔内高压患者的胃肠功能障碍的影响(1)
DOI：10.3760/cma.j.issn.1671-0282.2014.10.017
基金项目：浙江省科技厅资助项目(2011C23080)
通信作者：黄曼，Email：huangman122@sina.com
【摘要】目的 观察连续性血液净化治疗(CBP)治疗腹腔内高压(IAH)患者过程中对胃肠功能障碍的影响。方法 37例IAH患者分两组，治疗组20例，予以CBP治疗72 h；对照组17例予以常规治疗，在治疗0，24，72 h及第7天，测量腹腔内压力，统计胃肠道症状数目，计算后序贯器官衰竭评分(SOFA)评分。结果 接受CBP治疗后患者平均动脉压(MAP)无明显变化(P=0.218)，腹腔内压(IAP)显著下降(P=0.001)，腹腔灌注压(APP)也较前明显升高(P=0.036)；CBP组与对照组相比，入选24 h后有2个以上胃肠道症状的患者比例明显降低(P=0.049)，而72 h后CBP组有2个以上和3个以上胃肠道症状的患者比例均低于对照组(P<0.05)；接受CBP治疗后序贯器官衰竭评分(SOFA)评分较对照组明显下降(P=0.037)；两组患者的28 d及60 d病死率差异无统计学意义。结论 CBP治疗能降低IAP，从而使APP升高，改善内脏血供，使肠道功能显著恢复；本研究提示CBP治疗对患者预后无明显改善，但早期可改善腹腔高压患者胃肠道功能不全。
, 百拇医药
【关键词】血液净化；腹腔高压；胃肠功能障碍
Clinical study of the influence of continuous hemofiltration on gastrointestinal dysfunction of the patients with intra-abdominal hypertension Xu Xin， Huang Man， Wang Pengfei， Xu Qiuping. General Critical Care Unit， Second Affiliated Hospital， Zhejiang University School of Medicine， 310009 China
Corresponding Author： Huang Man， Email：huangman122@sina.com
【Abstract】Objective To investigate the effects of continuous hemofiltration on gastrointestinal dysfunction for treating patients with intra-abdominal hypertension.Methods A total of 37 patients were divided into two groups randomly(random number)， namely control group (n=17) and continuous blood filtration (CBF) group (n=20). The patients of control group were treated with routine treatment， and the patients of CBF group were given CBF for 72 hours in addition to the routine treatment. The intra-abdominal pressure (IAP)， gastrointestinal (GI) symptoms， and SOFA score were documented at 0 hour， 24 hours， 72 hours and 7 days after treatment. Results The MAP of patients in the CBF group was not significantly changed (P=0.218)， while the IAP was decreased significantly (P=0.001) and the abdominal perfusion pressure (APP) increased significantly after CBF (P=0.036). Compared with the control group， there were more than 2 GI symptoms markedly relieved after CBF for 24 hours (P=0.049).The SOFA score of CBF group decreased significantly (P=0.037). There were no differences in 28-day and 60-day mortality between two groups. Conclusions The CBF can decrease IAP， increase APP， improve splanchnic blood circulation， and ameliorate gastrointestinal dysfunction. But CBF does not reduce the mortality in comparison with routine treatment.
【Key words】Hemofiltration； Intra-abdominal hypertension； Gastrointestinal dysfunction
腹腔内高压(intra-abdominal hypertension，IAH)和腹腔内间室综合征(abdominal compartment syndrome，ACS)已经成为危重症医师日益关注的问题[1-3]。流行病学研究提示其在重症患者中发病率高达31%～59%[4-5]，并且IAH和ACS与病死率密切相关[6-8]。, 百拇医药(须欣 黄曼 王鹏飞 徐秋萍)
基金项目：浙江省科技厅资助项目(2011C23080)
通信作者：黄曼，Email：huangman122@sina.com
【摘要】目的 观察连续性血液净化治疗(CBP)治疗腹腔内高压(IAH)患者过程中对胃肠功能障碍的影响。方法 37例IAH患者分两组，治疗组20例，予以CBP治疗72 h；对照组17例予以常规治疗，在治疗0，24，72 h及第7天，测量腹腔内压力，统计胃肠道症状数目，计算后序贯器官衰竭评分(SOFA)评分。结果 接受CBP治疗后患者平均动脉压(MAP)无明显变化(P=0.218)，腹腔内压(IAP)显著下降(P=0.001)，腹腔灌注压(APP)也较前明显升高(P=0.036)；CBP组与对照组相比，入选24 h后有2个以上胃肠道症状的患者比例明显降低(P=0.049)，而72 h后CBP组有2个以上和3个以上胃肠道症状的患者比例均低于对照组(P<0.05)；接受CBP治疗后序贯器官衰竭评分(SOFA)评分较对照组明显下降(P=0.037)；两组患者的28 d及60 d病死率差异无统计学意义。结论 CBP治疗能降低IAP，从而使APP升高，改善内脏血供，使肠道功能显著恢复；本研究提示CBP治疗对患者预后无明显改善，但早期可改善腹腔高压患者胃肠道功能不全。
, 百拇医药
【关键词】血液净化；腹腔高压；胃肠功能障碍
Clinical study of the influence of continuous hemofiltration on gastrointestinal dysfunction of the patients with intra-abdominal hypertension Xu Xin， Huang Man， Wang Pengfei， Xu Qiuping. General Critical Care Unit， Second Affiliated Hospital， Zhejiang University School of Medicine， 310009 China
Corresponding Author： Huang Man， Email：huangman122@sina.com
【Abstract】Objective To investigate the effects of continuous hemofiltration on gastrointestinal dysfunction for treating patients with intra-abdominal hypertension.Methods A total of 37 patients were divided into two groups randomly(random number)， namely control group (n=17) and continuous blood filtration (CBF) group (n=20). The patients of control group were treated with routine treatment， and the patients of CBF group were given CBF for 72 hours in addition to the routine treatment. The intra-abdominal pressure (IAP)， gastrointestinal (GI) symptoms， and SOFA score were documented at 0 hour， 24 hours， 72 hours and 7 days after treatment. Results The MAP of patients in the CBF group was not significantly changed (P=0.218)， while the IAP was decreased significantly (P=0.001) and the abdominal perfusion pressure (APP) increased significantly after CBF (P=0.036). Compared with the control group， there were more than 2 GI symptoms markedly relieved after CBF for 24 hours (P=0.049).The SOFA score of CBF group decreased significantly (P=0.037). There were no differences in 28-day and 60-day mortality between two groups. Conclusions The CBF can decrease IAP， increase APP， improve splanchnic blood circulation， and ameliorate gastrointestinal dysfunction. But CBF does not reduce the mortality in comparison with routine treatment.
【Key words】Hemofiltration； Intra-abdominal hypertension； Gastrointestinal dysfunction
腹腔内高压(intra-abdominal hypertension，IAH)和腹腔内间室综合征(abdominal compartment syndrome，ACS)已经成为危重症医师日益关注的问题[1-3]。流行病学研究提示其在重症患者中发病率高达31%～59%[4-5]，并且IAH和ACS与病死率密切相关[6-8]。, 百拇医药(须欣 黄曼 王鹏飞 徐秋萍)