Relationship between intra-abdominai pressure and severity in pathents with severe acute pancreatitis
WANG Ya-jun, SUN Jia-bang, LI Fei, YANG Lei, CHEN Hong, LIU Da-chuan
Published 2009-06-10
Cite as Chin J Emerg Med, 2009,18(06): 632-635. DOI: 10.3760/cma.j.issn.1671-0282.2009.06.021
Abstract
Objective Previous investigations suggest that severe acute pancreatitis (SAP) is one of the main causes of intra-ahdominal pressure (lAP) increase. The aims of this study were, to evaluate the increased IAP in patients with SAP and the correlation between LAP and severity or prognosis. Method Data of 75 SAP patients admitted to Xuan-Wu Hospital of Capital Medical University intensive care unit with SAP from January 2000 to Jan-uary 2008 were collected. All the patients had at least one organ dysfunction, and they were diagnozed with en-hanced CT, lAP were monitored in the 56 patients. The 56 patients were divided into three groups according to IAP, group A (7- 15 mmHg), group B (16-25 mmHg) and group C (26-31 mmHg). Maximal APECHE Ⅱscore, maximal Ranson score, maximal C-response protein (CRP), maximal arterial lactate, maximal creatinine, organ dysfunction, length of stay and mortality were compared. Results The 56 patients (24 male and 32 female)with average age of (52±14.1) years (ranging 21 - 72 years) and average body mass index (BMI) of 28±12.5(ranging 21 - 35) were monitored with IAP. The etiologic causes of SAP were biliary in 27 patients, alcohol in 14cases, hyperlipidemia in 11 cases and idiopathic in 4 cases. The rate of intra-abdominal hypertension was 89% (50/56), and 32% (18/56) patients complicated with abdominal compartment syndrome. There were 22, 26 and 8 patients in the A, B and C groups respectively. With the increasing of IAP, the maximal APACHE Ⅱ, maximal Ranson score, maximal CRP, maximal creatinine, organ dysfunction and mortality were also increased significant-ly. The mortality of the three groups was 13.6% (3/22), 23.1% (6/26) and 62.5% (5/8) respectively (χ2 =7.56, p = 0.023), and the total mortality of the 56 patients was 25%. The hospital stay of the three groups had no significant differenee(F = 2.23,P = 0.117). Conclusions IAP may be one of the markers used to evaluate the severity of SAP, and the monitoring of IAP is useful to assess the prognosis in patients with SAP.
Key words:
Acute pancreatitis; Intra-abdominal pressure; Intra-abdominal hypertension; Abdominal com-partment syndrome; Diagnosis; Prognosis
Contributor Information
WANG Ya-jun
Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
SUN Jia-bang
Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
LI Fei
Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
YANG Lei
Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
CHEN Hong
Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
LIU Da-chuan
Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China