腹内高压与急性胰腺炎严重程度的相关性分析
| 作者: |
1赵煜,
1梁良
1 四川省人民医院 急诊外科，四川 成都 610072 |
| 通讯: |
梁良
Email: 52565896@qq.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2015.09.014 |
摘要
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 mmHg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。
关键词：
胰腺炎，急性坏死性；腹内高压；急性病生理学和长期健康评价
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 mmHg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。
Relationship between intra-abdominal hypertension and degree of severity of acute pancreatitis
CorrespondingAuthor:LIANG Liang Email: 52565896@qq.com
Abstract
Objective: To investigate the relationship between the intra-abdominal hypertension (IAH) and degree of severity of acute pancreatitis (AP).
Methods: Eighty AP patients admitted from February 2014 to February 2015 were selected. Of the patients, 49 cases were mild AP (MAP group) and 31 cases were severe AP (SAP group) according to their APACHE II scores at admission. The intra-abdominal pressure (IAP) of the patients was monitored via indirect bladder pressure measurement, 4 h per session for 5 d, and those with IAP value higher than 12 mmHg in two consecutive measurements were diagnosed as IAH. The incidence of IAH between the two groups was compared, and the correlation between IAP value and APACHE II score was analyzed; the incidence of adverse clinical events between cases with and without occurrence of IAH among SAP patients was compared, and the predictive values of APACHE II score and IAP for adverse clinical events were assessed by ROC curve analysis.
Results: The incidence of IAH in SAP group was significantly higher than that in MAP group (45.2% vs. 0%, P<0.05), and the results of Pearson correlation analysis showed that there was a positive correlation between IAP value and APACHE II (r=0.752, P<0.05); the incidence of each adverse clinical event in cases with IAH was significantly higher than that in cases without IAH among SAP patients (P<0.05), and the AUC of IAP value for predicting adverse clinical events was significantly greater than that of APACHE II score (0.892 vs. 0.610, P<0.05).
Conclusion: IAH is closely related to the degree of severity of AP, and it also may affect the clinical outcome of AP patients. IAP has important clinical value in predicting the risk of adverse clinical events in SAP patients.
Keywords：
Methods: Eighty AP patients admitted from February 2014 to February 2015 were selected. Of the patients, 49 cases were mild AP (MAP group) and 31 cases were severe AP (SAP group) according to their APACHE II scores at admission. The intra-abdominal pressure (IAP) of the patients was monitored via indirect bladder pressure measurement, 4 h per session for 5 d, and those with IAP value higher than 12 mmHg in two consecutive measurements were diagnosed as IAH. The incidence of IAH between the two groups was compared, and the correlation between IAP value and APACHE II score was analyzed; the incidence of adverse clinical events between cases with and without occurrence of IAH among SAP patients was compared, and the predictive values of APACHE II score and IAP for adverse clinical events were assessed by ROC curve analysis.
Results: The incidence of IAH in SAP group was significantly higher than that in MAP group (45.2% vs. 0%, P<0.05), and the results of Pearson correlation analysis showed that there was a positive correlation between IAP value and APACHE II (r=0.752, P<0.05); the incidence of each adverse clinical event in cases with IAH was significantly higher than that in cases without IAH among SAP patients (P<0.05), and the AUC of IAP value for predicting adverse clinical events was significantly greater than that of APACHE II score (0.892 vs. 0.610, P<0.05).
Conclusion: IAH is closely related to the degree of severity of AP, and it also may affect the clinical outcome of AP patients. IAP has important clinical value in predicting the risk of adverse clinical events in SAP patients.