小儿脓毒症并腹内高压的危险因素分析

张笃飞; 冯小伟; 林涛; 吴开芳

doi:10.7499/j.issn.1008-8830.2013.07.007

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中国当代儿科杂志 ›› 2013, Vol. 15 ›› Issue (7) : 530-534. DOI: 10.7499/j.issn.1008-8830.2013.07.007

论著·临床研究

小儿脓毒症并腹内高压的危险因素分析

张笃飞，冯小伟，林涛，吴开芳

作者信息 +

Risk factors for intra-abdominal hypertension in children with sepsis

ZHANG Du-Fei, FENG Xiao-Wei, LIN Tao, Wu Kai-Fang

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摘要

目的：探讨小儿脓毒症并腹内高压（IAH）的危险因素, 为早期诊断、及时干预治疗提供理论依据。方法：采用膀胱测压法对119例脓毒症患儿进行腹内压检测，根据腹内压检测结果将患儿分为腹内压正常组(对照组，n=80)与IAH组(n=39)。采用单因素和非条件logistic回归分析对两组患儿的临床资料进行分析，以调查脓毒症患儿并发IAH的危险因素。结果：单因素分析发现小儿危重病评分（PCIS）、降钙素原（PCT）、PaCO2、血清乳酸值及肠道/腹腔感染、腹水、胃肠功能障碍、机械通气、休克和多脏器功能不全（MODS）的发生比例在IAH和对照组间比较差异均具有统计学意义（P<0.05）。Logistic回归分析显示PCIS降低、MODS、休克、胃肠功能障碍和腹水是脓毒症合并IAH的主要危险因素。结论：PCIS降低、MODS、休克、胃肠功能障碍和腹水的脓毒症患儿, 有发生IAH的可能, 应重点监测，以早期诊断并予及时干预治疗。

Abstract

OBJECTIVE: To study risk factors for the occurrence of intra-abdominal hypertension (IAH) in children with sepsis. METHODS: A nest case-control study was employed. According to intra-abdominal pressures (IAP) measured by cystometry, 119 children with sepsis were classified into normal IAP (control, n=80) and IAH groups (n=39). Risk factors for the occurrence of IAH were investigated by monovariable and multivariable logistic regression analysis. RESULTS: Monovariable analysis showed that there were significant differences in pediatric critical illness score (PCIS), procalcitonin (PCT) level, PaCO2, blood lactate level, rates of intestinal or intra-abdominal infection, ascites, gastrointestinal dysfunction, mechanical ventilation, shock and multiple organ dysfunction syndrome (MODS) between the IAH and control groups (P<0.05). Multivariable logistic regression analysis demonstrated that decreased PCIS, MODS, shock, gastrointestinal dysfunction and ascites were major risk factors for the occurrence of IAH. CONCLUSIONS: Children with sepsis who have decreased PCIS, MODS, shock, gastrointestinal dysfunction and ascites are at risk for the occurrence of IAH.

导出引用

张笃飞，冯小伟，林涛，吴开芳. 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 https://doi.org/10.7499/j.issn.1008-8830.2013.07.007

ZHANG Du-Fei, FENG Xiao-Wei, LIN Tao, Wu Kai-Fang. Risk factors for intra-abdominal hypertension in children with sepsis[J]. Chinese Journal of Contemporary Pediatrics. 2013, 15(7): 530-534 https://doi.org/10.7499/j.issn.1008-8830.2013.07.007

参考文献

［1］刘成军,白科.小儿腹内高压和腹腔间室综合征的诊断与治疗［J］.实用儿科临床杂志,2012,27(18):1390-1392.

［2］Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference:definitions for sepsis and organ dysfunction in pediatrics［J］.Pediatr Crit Care Med, 2005, 6(1):2-8.

［3］樊寻梅,武志远.国际儿科脓毒症定义会议介绍［J］.中华儿科杂志,2005,43(8):618-620.

［4］Cheatham ML.Abdominal compartment syndrome［J］.Curr Opin Crit Care, 2009, 15(2):154-162.

［5］Watson RS,Carcillo JA.Scope and epidemiology of pediatric sepsis［J］.Pediatr Crit Care Med, 2005, 6(3 Suppl): 3-5.

［6］Shorr AF,Micek ST, Jackson WL Jr, Kollef MH.Economic implications of an evidence based sepsis protocol:can we improve outcomes and lower costs［J］.Crit Care Med, 2007, 35(5): 1257-1262.

［7］Regueira T, Hasbun P, Rebolledo R, Galindo J, Aguirre M,Romero C,et al. Intra-abdominal hypertension in patients with septic shock［J］.Am Surg, 2007, 73(9): 865-870.

［8］段红丽,沈芳.重症监护室严重脓毒症患儿死亡危险因素分析［J］.中国全科医学,2011,29(10):3352-3354.

［9］Regueira T, Hasbun P, Rebolledo R, Galindo J, Aguirre M, Romero C, et al. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria［J］.Intensive Care Med, 2012, 38(5): 811-819.

［10］Kenzaka T, Okayama M, Kuroki S, Fukui M, Yahata S, Hayashi H, et al. Importance of vital signs to the early diagnosis and severity of sepsis: association between vital signs and sequential organ failure assessment score in patients with sepsis［J］.Intern Med, 2012, 51(8): 871-876.

［11］Puleo F, Arvanitakis M, Van Gossum A, Preiser JC. Gut failure in the ICU［J］. Semin Respir Crit Care Med, 2011, 32(5): 626-638.

［12］De Winter BY, De Man JG. Interplay between inflammation, immune system and neuronal pathways: effect on gastrointestinal motility［J］.World J Gastroenterol, 2010, 16(44): 5523-5535.

［13］Gallagher JJ. Intra-abdominal hypertension:detecting and managing a lethal complication of critical illness［J］.AACN Adv Crit Care, 2010, 21(2): 205-219.

［14］Hedenstierna G, Larsson A.Influence of abdominal pressure on respiratory and abdominal organ function［J］.Curr Opin Crit Care, 2012, 18(1):80-85.

［15］Regueira T, Bruhn A, Hasbun P, Aguirre M, Romero C, Llanos O,et al. Intra-abdominal hypertension: incidence and association with organ dysfunction during early septic shock［J］.J Crit Care, 2008, 23(4): 461-467.

［16］张泉,吴晓琳.脓毒症患儿并发胃肠功能障碍对预后的影响［J］.中国当代儿科杂志,2010,12(2):141-142.

［17］Druey KM,Greipp PR.Narrative review:the systemic capillary leak syndrome［J］.Ann Intern Med, 2010, 153(2): 90-98.

［18］李玉梅,冉杰,李恒,严超英.新生儿毛细血管渗漏综合征的高危因素分析［J］.中国当代儿科杂志,2011,13(9):708-710.

［19］Cheatham ML,Safcsak K.Intraabdominal hypertension and abdominal compartment syndrome: The journey forward［J］.Am Surg, 2011, 77(Suppl 1):1-5.