Intra-abdominal hypertensionand acute renal failurein critically ill patients
Intra-abdominal hypertensionand acute renal failurein critically ill patients
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DOI：
10.1007/s00134-007-0969-4
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发表时间：
2008-04-01
影响因子：
38.9
通讯作者：
Brienza, Nicola
中科院分区：
文献类型：
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作者：
Dalfino, Lidia;Tullo, Livio;Brienza, Nicola
目的：探讨危重患者腹内高压(IAH)与急性肾功能衰竭(ARF)的关系。设计和地点：在普通重症监护室进行前瞻性观察性研究。患者：6个月内连续入院24小时的患者。干预：无。测量和结果：采用膀胱压力测量法测量腹内压(IAP)。IAH被定义为至少连续两次以24小时间隔进行的IAP&>=12毫米汞柱。ARF被定义为步枪分类中的失效等级。123例患者中，37例(30.1%)发生了IAH。发生ARF 23例(总发生率19%)，IAH组16例(43.2%)，非IAH组7例(8.1%)(p<；0.05)。休克(P<；0.001)、IAH(P=0.002)和低腹部灌流压(APP；P=0.046)是预测ARF的最佳因素。IAP诊断ARF的最佳临界点为12 mm Hg，其敏感性为91.3%，特异性为67%。APP和滤过梯度(FG)诊断ARF的最佳临界值分别为52和38 mm Hg。年龄(p=0.002)、累积液体平衡(p=0.002)和休克(p=0.006)是IAH的独立预测因素。IAH患者的原始医院死亡率显著较高；然而，风险调整后的死亡率和O/E比率在不同组之间没有差异。结论：在危重病患者中，IAH是低至12毫米汞柱的IAP水平的ARF的独立预测因子，尽管也应考虑全身血流动力学受损的影响。
Objective: To investigate the relationship between intra-abdominal hypertension (IAH) and acute renal failure (ARF) in critically ill patients. Design and setting: Prospective, observational study in a general intensive care unit. Patients: Patients consecutively admitted for > 24 h during a 6-month period. Interventions: None. Measurements and results: Intra-abdominal pressure (IAP) was measured through the urinary bladder pressure measurement method. The IAH was defined as a IAP >= 12 mmHg in at least two consecutive measurements performed at 24-h intervals. The ARF was defined as the failure class of the RIFLE classification. Of 123 patients, 37 (30.1%) developed IAH. Twenty-three patients developed ARF (with an overall incidence of 19%), 16 (43.2%) in IAH and 7 (8.1%) in non-IAH group (p < 0.05). Shock (p < 0.001), IAH (p = 0.002) and low abdominal perfusion pressure (APP; p = 0.046) resulted as the best predictive factors for ARF. The optimum cut-off point of IAP for ARF development was 12 mmHg, with a sensitivity of 91.3% and a specificity of 67%. The best cut-off values of APP and filtration gradient (FG) for ARF development were 52 and 38 mmHg, respectively. Age(p = 0.002), cumulative fluid balance (p = 0.002) and shock (p = 0.006) were independent predictive factors of IAH. Raw hospital mortality rate was significantly higher in patients with IAH; however, risk-adjusted and O/E ratio mortality rates were not different between groups. Conclusions: In critically ill patients IAH is an independent predictive factor of ARF at IAP levels as low as 12 mmHg, although the contribution of impaired systemic haemodynamics should also be considered.