|本期目录/Table of Contents|

[1]谢文慧,叶向红,徐瑶,等.重症急性胰腺炎患者腹内高压与机械通气相关因素分析[J].医学研究与战创伤救治(原医学研究生学报),2023,25(2):117-121.[doi:10.3969/j.issn.1672-271X.2023.02.002]
　XIE Wenhui,YE Xianghong,XU Yao,et al.Analysis of the relationship between severe acute pancreatitis patients with intra-abdominal hypertension and mechanical ventilation associated factors[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2023,25(2):117-121.[doi:10.3969/j.issn.1672-271X.2023.02.002]
点击复制

重症急性胰腺炎患者腹内高压与机械通气相关因素分析()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第25卷
期数:
2023年2期
页码:
117-121
栏目:
临床研究
出版日期:
2023-05-31

文章信息/Info

Title:
Analysis of the relationship between severe acute pancreatitis patients with intra-abdominal hypertension and mechanical ventilation associated factors
作者:
谢文慧; 叶向红; 徐瑶; 路佳慧; 李嘉琪; 左俊焘; 韩珍
作者单位：233030蚌埠，蚌埠医学院护理学院（谢文慧、徐瑶、路佳慧）；210002南京，东部战区总医院普通外科（叶向红）；210093南京，南京大学医学院（李嘉琪、左俊焘、韩珍）
Author(s):
XIE Wenhui1;  YE Xianghong2; XU Yao1; LU Jiahui1; LI Jiaqi3; ZUO Juntao3; HAN Zhen3
(1.Department of Nursing, Bengbu Medical College,Bengbu 233030,Anhui,China;2.Department of General Surgery,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;3.Medical School of Nanjing University，Nanjing 210093,Jiangsu,China)
关键词:
重症急性胰腺炎; 腹内压; 机械通气
Keywords:
severe acute pancreatitis;  intra-abdominal pressure;  mechanical ventilation
分类号:
R576
DOI:
10.3969/j.issn.1672-271X.2023.02.002
文献标志码:
A
摘要:
目的探讨重症急性胰腺炎（SAP）患者腹内压对机械通气相关因素和预后的影响，以及腹内高压的因素影响。方法回顾性分析2020年1月-2022年7月东部战区总医院胰腺治疗中心重症监护室行机械通气的SAP患者临床资料，分析机械通气前3天监测的最高腹内压与当时血流动力情况、呼吸功能监测参数的相关性。根据第1天是否发生腹内高压分为2组，比较年龄、性别、病因、BMI、急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）、急性生理与慢性病评分Ⅱ（APACHEⅡ）、通气方式、呼吸机模式、呼吸末正压（PEEP）对腹内高压的影响。结果收集174例机械通气SAP患者，机械通气前3天发生腹内高压占比分别为59.77%、67.24%、68.39%。将腹内压与机械通气相关参数进行相关性分析显示，腹内压与气道峰压（Ppeak）、PaCO2呈正相关（r＞0，P＜0.05），与pH、PaO2/FiO2呈负相关（r＜0，P＜0.05），腹内压与血流动力学之间无相关性（P＞0.05）。预测腹内高压的多因素Logistics回归分析显示，BMI（OR=1.174，95%CI:1.059~1.302）、PEEP（OR=1.238，95%CI:1.014~1.511）为SAP患者出现腹内高压的独立危险因素。BMI、PEEP每增加1个单位，腹内高压的风险就分别增加17.4%、23.8%，再根据多因素分析结果作ROC曲线显示，BMI、PEEP预测腹内高压的ROC曲线下面积分别为0.734(95%CI:0.652~0.816）、0.690(95%CI:0.606~0.775），其预测腹内高压发生的临界值分别为25.865 kg/m2、6.5 cmH2O。结论BMI、PEEP是腹内高压的独立危险因素。腹内高压可直接或间接影响呼吸功能，同时腹内压也随机械通气PEEP值的增加而升高，选择最佳PEEP对平衡腹腔压与肺容积至关重要。
Abstract:
ObjectiveTo investigate the effect of intra-abdominal pressure (IAP) on mechanical ventilation related factors and prognosis in patients with severe acute pancreatitis (SAP), and to explore the influencing factors of intra-abdominal hypertension.MethodsThe ICU data of SAP patients who used mechanical ventilation from January 2020 to July 2022 in General Hospital of Eastern Theater Command was retrospected and analysed of the relationship bewteen IAP during the first three days of the mechanical ventilation and the blood flow dynamic condition, the correlation of respiratory function monitoring parameters. The patients were divided into two groups according to the occurrence of intraperitoneal hypertension on the first day. The relationship were analysed between age, sex, etiology, BMI, acute lung injury/acute respiratory distress syndrome (ALI/ARDS), acute physiology and chronic health evaluation scoring system Ⅱ(APACHEⅡ), ventilation mode, ventilator mode, positive end-expiratory pressure (PEEP), prognostic indicators and intra-abdominal hypertension.ResultsOne hundred and seventy-four SAP patients with mechanical ventilation were collected. The proportion of intra-abdominal hypertension in the first three days of mechanical ventilation was 59.77%, 67.24% and 68.39%, respectively. The correlation analysis of parameters related to internal abdominal pressure and mechanical ventilation showed that the internal abdominal pressure was positively correlated with airway peak pressure (Ppeak) and PaCO2 (r＞0, P＜0.05), but negatively correlated with PH and PaO2/FiO2 (r＜0, P＜0.05), and there was no correlation between the internal abdominal pressure and hemodynamics (P＞0.05). The multi-factor Logistics regression analysis for predicting intra-abdominal hypertension showed that BMI (OR=1.174, 95%CI：1.059-1.302) and PEEP (OR=1.238, 95%CI：1.014-1.511) were risk factors for the occurrence of intra-abdominal hypertension in SAP patients. When BMI and PEEP increased by 1 unit, the risk of intra-abdominal hypertension increased by 17.4% and 23.8%, respectively. Then ROC curve was made according to the results of multivariate analysis. The area under ROC curve of BMI and PEEP to predict intraabdominal hypertension were 0.734 (95%CI:0.652-0.816) and 0.690 (95%CI:0.606-0.775), respectively, and the critical values for predicting intraabdominal hypertension were 25.865 kg/m2 and 6.5 cmH2O, respectively.ConclusionBMI and PEEP were independent risk factors of abdominal hypertension. Intraabdominal hypertension can directly or indirectly affect respiratory function. With the increasing of PEEP, the intraabdominal pressure also increases in mechanical ventilation at the same time. Selecting the optimal PEEP is crucial to balance abdominal pressure and lung volume.

参考文献/References:

[1]van Dijk SM, Hallensleben N, van Santvoort HC, et al. Acute pancreatitis: recent advances through randomised trials[J]. Gut, 2017,66(11):2024-2032.
[2]Trikudanathan G, Wolbrink DRJ, van Santvoort HC, et al. Current Concepts in Severe Acute and Necrotizing Pancreatitis: An Evidence-Based Approach[J]. Gastroenterology, 2019,156(7):1994-2007.
[3]Li Y, Ren J, Wu X, et al. Intra-abdominal infection combined with intra-abdominal hypertension aggravates the intestinal mucosal barrier dysfunction[J]. Biosci Rep, 2018,38(1).doi: 10.1042/BSR20170931.
[4]Párraga RE, Correa-Martín L, Sánchez-Margallo FM, et al. Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension[J]. Surg Endosc, 2018,32(9):3989-4002.
[5]Malbrain M. The saga continues: How to set best PEEP in intra-abdominal hypertension?[J] J Crit Care, 2018,43:387-389.
[6]王晓冬, 罗家鑫, 霍习敏, 等. 腹内压监测在小儿重症肺炎机械通气中的应用价值[J]. 中国全科医学, 2021,24(5):555-560.
[7]Fiedler MO, Deutsch BL, Simeliunas E, et al. Effect of moderate elevated intra-abdominal pressure on lung mechanics and histological lung injury at different positive end-expiratory pressures[J]. PLoS One, 2020,15(4):e230830.
[8]Heijnen BG, Spoelstra-de MA, Groeneveld AB. Low Transmission of Airway Pressures to the Abdomen in Mechanically Ventilated Patients With or Without Acute Respiratory Failure and Intra-Abdominal Hypertension[J]. J Intensive Care Med, 2017,32(3):218-222.
[9]Boxhoorn L, Voermans RP, Bouwense SA, et al. Acute pancreatitis[J].Lancet, 2020,396(10252):726-734.
[10]Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013,62(1):102-111.
[11]IAP/APA evidence-based guidelines for the management of acute pancreatitis[J]. Pancreatology, 2013,13(4 Suppl 2):e1-e15.
[12]Regli A, Pelosi P, Malbrain M. Ventilation in patients with intra-abdominal hypertension: what every criticalcare physician needs to know[J]. Ann Intensive Care, 2019,9(1):52.
[13]阿不都热合曼·阿不都卡地尔, 玉山江·阿布都热合曼, 衣力哈木·居热艾提, 等. 腹内压监测对ICU机械通气患者病情及预后判断的意义[J]. 交通医学, 2020,34(1):41-43.
[14]Regli A, Ahmadi-Noorbakhsh S, Musk GC, et al. Computed tomographic assessment of lung aeration at different positive end-expiratory pressures in a porcine model of intra-abdominal hypertension and lung injury[J]. Intensive Care Med Exp, 2021,9(1):52.
[15]agosz P, Sokolski M, Biegus J, et al. Elevated intra-abdominal pressure: A review of current knowledge[J]. World J Clin Cases, 2022,10(10):3005-3013.
[16]Tonetti T, Cavalli I, Ranieri VM, et al. Respiratory consequences of intra-abdominal hypertension[J]. Minerva Anestesiol, 2020,86(8):877-883.
[17]Sun J, Sun H, Sun Z, et al. Intra-abdominal hypertension and increased acute kidney injury risk: a systematic review and meta-analysis[J]. J Int Med Res, 2021,49(5):675889741.
[18]Richer-Séguin , Ayoub C, Lebon JS, et al. Intra-abdominal pressure during and after cardiac surgery: a single-centre prospective cohort study[J]. Can J Anaesth, 2022,69(2):234-242.
[19]Reintam BA, Regli A, De Keulenaer B, et al. Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study)[J]. Crit Care Med, 2019,47(4):535-542.
[20]Krebs J, Pelosi P, Tsagogiorgas C, et al. Effects of positive end-expiratory pressure on respiratory function and hemodynamics in patients with acute respiratory failure with and without intra-abdominal hypertension: a pilot study[J]. Critical Care, 2009,13(5):R160.
[21]Smit M, van Meurs M, Zijlstra JG. Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps[J]. Scand J Surg，2022,111(1):14574969211030128. doi: 10.1177/14574969211030128.
[22]Tyson N, Efthymiou C. Predictive risk factors for intra-abdominal hypertension after cardiac surgery[J]. Interact Cardiovasc Thorac Surg, 2021,32(5):719-723.
[23]Nazer R, Albarrati A, Ullah A, et al. Intra-abdominal hypertension in obese patients undergoing coronary surgery: Aprospective observational study[J]. Surgery, 2019,166(6):1128-1134.
[24]Liang Y, Tao S, Gu B, et al. Intra-abdominal Pressure Has a Good Predictive Power for 28-Day Mortality: A Prospective Observational Study Conducted in Critically Ill Children[J]. Front Pediatr, 2020,8:567876.
[25]Ball CG, Kirkpatrick AW. ‘Progression towards the minimum’: the importance of standardizing the priming volume during the indirect measurement of intra-abdominal pressures[J]. Crit Care, 2006,10(4):153.
[26]Hamoud S, Abdelgani S, Mekel M, et al. Gastric and urinary bladder pressures correlate with intra-abdominal pressure in patients with morbid obesity[J]. J Clin Monit Comput, 2022,36(4):1021-1028.
[27]De Keulenaer BL, De Waele JJ, Powell B, et al. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure?[J] Intensive Care Med, 2009,35(6):969-976.
[28]Regli A, De Keulenaer BL, Palermo A, et al. Positive end-expiratory pressure adjusted for intra-abdominal pressure - A pilot study[J]. J Crit Care, 2018,43:390-394.

相似文献/References:

[1]吴万桂,周仁荣,黄家淼.重症急性胰腺炎并发腹腔间隔室综合征的诊疗现状[J].医学研究与战创伤救治(原医学研究生学报),2013,15(04):384.[doi:10.3969/j.issn.1672-271X.2013.04.021]
[2]伏添,栾正刚,张谞丰.重症急性胰腺炎并发胰性脑病早期危险因素分析[J].医学研究与战创伤救治(原医学研究生学报),2021,23(03):257.[doi:10.3969/j.issn.1672-271X.2021.03.008]
　FU Tian,LUAN Zheng-gang,ZHANG Xu-feng.Analysis of early risk factors of the pancreatic encephalopathy in patients with severe acute pancreatitis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2021,23(2):257.[doi:10.3969/j.issn.1672-271X.2021.03.008]
[3]张锐,顾璐璐,叶向红,等.创伤后行腹腔开放患者肠内营养并发症管理的研究进展[J].医学研究与战创伤救治(原医学研究生学报),2021,23(04):397.[doi:10.3969/j.issn.1672-271X.2021.04.013]
　ZHANG Rui,GU Lu-lu,YE Xiang-hong,et al.The management of complications of enteral nutrition in patients with open abdomen after trauma[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2021,23(2):397.[doi:10.3969/j.issn.1672-271X.2021.04.013]

备注/Memo

备注/Memo:
基金项目：军事医学创新工程项目（18CXZ040）
更新日期/Last Update: 2023-07-24