持续性血液净化治疗对腹腔内高压患者胃肠功能障碍影响.docVIP

持续性血液净化治疗对腹腔内高压患者胃肠功能障碍影响 　　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@ 　　【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（P0.05）；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。 　　【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@ 　　【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）.T