小儿脓毒症并腹内高压的危险因素分析

Risk factors for intra-abdominal hypertension in children with sepsis

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.