儿童重症监护病房危重患儿腹内压的监测及价值
海南省妇女儿童医学中心, 儿科, 海南海口 570100
| 摘 要： | 目的：研究并检测腹内压（IAP）在儿童重症监护病房（PICU）危重患儿监测和治疗中的临床价值。方法：对我院PICU病房2023年9月至2023年12月收治的86例重症患儿进行动态膀胱内压监测，分析腹IAP升高对呼吸功能、血流动力学及病情等方面变化的影响。并给予对症的降腹内高压治疗。结果：常规监测86例PICU患儿中，首次IAP监测前后患儿心率、血压、呼吸、末梢血氧饱和度等改变无统计学意义（P>0.05）；IAP升高组小儿危重病症评分（PCIS）、尿量低于IAP正常组，中心静脉压（CVP）、血乳酸水平高于IAP正常组，有显著性差异（P<0.01）。IAP与CVP、血乳酸水平的相关系数分别为0.417，0.300（P<0.01），腹内压与PCIS、尿量的相关系数分别为-0.499，-0.483（P<0.01）。IAP升高组经过降IAP治疗后PCIS较治疗前升高、尿量增多，CVP、乳酸逐渐降低（P<0.05或P<0.01）。结论：经膀胱内测压法测量IAP的安全性高，简便易行，创伤性小；动态监测重症患儿的IAP有一定的临床价值；采取及时有效的治疗措施降低IAP有助于改善患儿病情。 |
| 关 键 词： | 腹内压; 膀胱内压; 腹内高压; 儿童重症监护病房 |
| DOI： | 10.57237/j.wjcm.2024.02.002 |
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收稿日期: 2024-06-04
接受日期: 2024-07-16
在线出版日期: 2024-07-18
Monitoring and Value of Intra-abdominal Pressure in Critically Ill Children in Pediatric Intensive Care Unit
Pediatric Department, Hainan Women and Children's Medical Center, Haikou 570100, China
| Abstract: | Objective: To study and test the critical comprehensive value of intra-abdominal pressure (IAP) in monitoring and treatment of PICU patients. Methods: Via monitoring the dynamic bladder pressure of 86 cases of severe children admitted to our PICU from September 2023 to December 2023, the influences of increased IAP on the respiratory function, blood flow dynamics and condition were analyzed. Symptomatic treatments were performed for the children with intra-abdominal hypertension. Results: In the routine examination of 86 PICU patients, the changes of heart rate, blood pressure, breathing and peripheral blood oxygen saturation before and after the first IAP monitoring had no significant differences in statistics (P>0.05). The pediatric critical illness score (PCIS) and urine volume in the group with high IAP were obviously lower, while the central venous pressure (CVP) and blood lactate level were obviously higher than those of the group with normal IAP (P<0.01). The correlation coefficient between IAP and CVP, blood lactate level were 0.417, 0.300, respectively (P<0.01). The correlation coefficient between IAP and PCIS, urine volume were -0.499, -0.483, respectively (P<0.01). After treatment to reduce intra-abdominal hypertension, PCIS, urine volume of the group with high IAP increased significantly, and CVP, blood lactate level decreased gradually (P<0.05 or P<0.01). Conclusions: The trans-bladder manometry method is high safety, feasible and small traumatic for the measurement of IAP. Dynamic monitoring of IAP in severe children has certain clinical value. Taking timely and effective treatment measures to reduce IAP can help to improve the condition of the children. |
| Keywords: | Intra-abdominal Pressure; Bladder Pressure; Intra-abdominal Hypertension; Pediatric Intensive Care Unit |
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