重症儿童腹腔内高压的高危因素及其对预后的影响

doi:10.3969/j.issn.1002-1949.2017.12.013

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摘要目的: 了解重症儿童腹腔内高压（intra-abdominal hypertension，IAH）发生率及其对预后的影响，探讨导致IAH发生的高危因素。方法: 2013-12～2016-06开展2个中心儿童重症监护室（pediatric intensive care unit, PICU）前瞻性观察研究，参与研究的2个PICU均属综合性儿童内外科ICU，入组年龄≤14岁、PICU治疗时间＞24 h且期间有留置尿管的患儿，采用膀胱测压法监测腹腔内压力（intra-abdominal pressure, IAP）并记录临床资料；应用单因素和多因素Logistic回归分析筛选IAH高危因素，使用生存曲线评估预后。结果: 研究共纳入458例患儿，其中IAH(IAP＞10 mm Hg)为180例 (39.3%)。腹部肿瘤(OR 9.7, 95% CI 1.1～93.8, P=0.04)、乳酸(OR 2.4, 95% CI 1.1～5.3,P=0.03)和非腹部疾病(OR 0.1, 95% CI 0.1～0.2,P＜0.001)是重症儿童IAH发生的独立危险因素。肥胖、机械通气和呼气末正压(PEEP)对IAH的影响无明显统计学意义。IAH组与非IAH组机械通气时间比较差异无统计学意义(P＞0.05)，两组患儿住院时间(P=0.02)及60 d病死率比较差异有统计学意义(P＜0.01)。两组患儿60 d生存曲线比较差异有统计学意义(P＜0.001)。结论: IAH在重症儿童中有较高的发生率，腹部肿瘤、乳酸升高是重症儿童IAH发生的高危因素，IAH患儿住院时间更长、病死率更高。

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	梁玉坚
	李素萍
	陶少华
	黄慧敏
	裴瑜馨
	唐雯

收稿日期: 2017-08-30

基金资助:广州市科技计划项目科学研究专项（1563000188）；2016年NST基金项目

通讯作者: 唐雯（1962-），女，主任医师，PICU主任, E-mail:tangwen@mail.sysu.edu.cn

作者简介: 梁玉坚（1984-），女，硕士，E-mail:ireneleong@126.com

引用本文:

梁玉坚，李素萍，陶少华，黄慧敏，裴瑜馨，唐雯. 重症儿童腹腔内高压的高危因素及其对预后的影响[J]. 中国急救医学, 2017, 37(12): 1129-1133.
Liang Yu-jian, Li Su-ping, Tao Shao-hua, Huang Hui-min, Pei Yu-xin, Tang Wen. The risk factors and prognosis of intra-abdominal hypertension in critically ill children. Chinese Journal of Critical Care Medicine, 2017, 37(12): 1129-1133.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2017.12.013 或 http://www.cnemergency.org.cn/CN/Y2017/V37/I12/1129

［1］Roberts DJ, Ball CG, Kirkpatrick AW. Increased pressure within the abdominal compartment: intra-abdominal hypertension and the abdominal compartment syndrome ［J］. Curr Opin Crit Care, 2016, 22(2):174-185. ［2］Kim IB, Prowle J, Baldwin I, et al. Incidence, risk factors and outcome associations of intra-abdominal hypertension in critically ill patients［J］. Anaesth Intensive Care, 2012, 40(1):79-89. ［3］Steinau G, Kaussen T, Bolten B, et al. Abdominal compartment syndrome in childhood: diagnostics, therapy and survival rate ［J］. Pediatr Surg Int, 2011, 27(4):399-405. ［4］Horoz OO, Yildizdas D, Asilioglu N, et al. The prevalance of and factors associated with intra-abdominal hypertension on admission day in critically ill pediatric patients: A multicenter study ［J］. J Crit Care, 2015, 30(3):584-588. ［5］Newcombe J, Mathur M, Ejike JC. Abdominal compartment syndrome in children ［J］. Crit Care Nurse, 2012, 32(6):51-61. ［6］Thabet FC, Bougmiza IM, Chehab MS, et al. Incidence, risk factors, and prognosis of intra-abdominal hypertension in critically ill children: a prospective epidemiological study［J］. J Intensive Care Med, 2016, 31(6):403-408. ［7］Akhobadze GR, Chkhaidze MG, Kanjaradze DV, et al. Identification, management and complications of intra-abdominal hypertension and abdominal compartment syndrome in neonatal intensive care unit (a single centre retrospective analysis) ［J］. Georgian Med News, 2011, 3 (192):58-64. ［8］梁玉坚,唐雯,黄慧敏,等.儿科医护人员对腹腔间隙综合征的知晓度调查［J］. 重庆医学, 2015, 15:2101-2103. ［9］Holodinsky JK, Roberts DJ, Ball CG, et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis［J］. Crit Care, 2013, 17(5):R249. ［10］李寅,王勇强,曹书华,等.ICU内腹内压升高的危险因素及对预后影响的临床观察［J］.中国急救医学, 2007, 27(6):533-535. ［11］张笃飞,冯小伟,林涛,等.小儿脓毒症并腹内高压的危险因素分析［J］.中国当代儿科杂志, 2013, 15(7):530-534. ［12］De Waele JJ, Ejike JC, Leppaniemi A, et al. Intra-abdominal hypertension and abdominal compartment syndrome in pancreatitis, paediatrics, and trauma［J］. Anaesthesiol Intensive Ther, 2015, 47(3):219-227. ［13］Thabet FC, Bougmiza IM, Chehab MS, et al. Incidence, risk factors, and prognosis of intra-abdominal hypertension in critically ill children: a prospective epidemiological study［J］. J Intensive Care Med, 2016, 31(6):403-408. ［14］Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome ［J］. Intensive Care Med, 2013, 39(7):1190-1206. ［15］梁玉坚，徐玲玲，唐雯. 2013版儿童腹腔内高压及腹腔间隙综合征国际指南解读［J］. 中华危重病急救医学, 2014, 26(7):454-457. ［16］Ejike JC, Mathur M, Moores DC. Abdominal compartment syndrome: focus on the children ［J］. Am Surg, 2011, 77(Suppl 1):S72-S77. ［17］梁玉坚,黄慧敏,徐玲玲,等.控制引流治疗腹腔积液继发腹腔间隙综合征［J］.中国急救医学, 2014,(10):889-893. ［18］Avraamidou A, Marinis A, Asonitis S, et al. The impact of ischemic preconditioning on hemodynamic, biochemical and inflammatory alterations induced by intra-abdominal hypertension: an experimental study in a porcine model［J］. Langenbecks Arch Surg, 2012, 397(8):1333-1341. ［19］Shaheen AW, Crandall ML, Nicolson NG, et al. Abdominal compartment syndrome in trauma patients: new insights for predicting outcomes［J］. J Emerg Trauma Shock, 2016, 9(2):53-57.  ［20］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. ［21］Reintam Blaser A, Parm P, Kitus R, et al. Risk factors for intra-abdominal hypertension in mechanically ventilated patients［J］. Acta Anaesth Scand, 2011, 55(5):607-614. ［22］Ahmadi-Noorbakhsh S, Malbrain ML. Integration of inspiratory and expiratory intra-abdominal pressure: a novel concept looking at mean intra-abdominal pressure［J］. Ann Intensive Care, 2012, 2( Suppl 1):S18.