成人ICU患者腹内高压危险因素的Meta分析

doi:10.3761/j.issn.2096-7446.2023.09.004

摘要/Abstract

摘要： 目的通过Meta分析明确成人ICU患者发生腹内高压的危险因素。方法计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、Cochrane Library、PubMed、Web of Science、Embase数据库,从建库至2022年12月关于成人ICU患者发生腹内高压危险因素的文献,由2名评价人员按照标准独立筛选文献、提取资料、评价文献质量。采用RevMan 5.4软件对资料进行Meta分析。结果共纳入17篇文献,总计3 250例成人ICU患者,有统计学意义的危险因素包括BMI（MD=3.09）、24 h液体输入量（MD=0.98）、机械通气（OR=3.40）、PaO₂/FiO₂（MD=-17.18）、急性生理与慢性健康状况评分（MD=4.04）、脓毒症（OR=2.42）、肠梗阻（OR=11.67）、腹部手术（OR=2.10）。结论 BMI越高、24 h液体输入量越大、急性生理与慢性健康状况评分越高、PaO₂/FiO₂越低、接受机械通气、合并脓毒症、肠梗阻、腹部手术史的成人ICU患者,发生腹内高压的风险越高。医护人员应动态评估和监测成人ICU患者的腹内压情况,采取针对性、个体化干预措施预防腹内高压的发生。

关键词: 重症监护病房, 腹内高压, 危险因素, Meta分析, 循证护理学

Abstract: Objective To identify the risk factors of intra-abdominal hypertension among adult ICU patients by meta-analysis. Methods We searched databases including CNKI,Wanfang Data,VIP,CBM,Cochrane Library,PubMed,Web of Science and Embase from inception to December 2022,to collect studies on risk factors for intra-abdominal hypertension of adult ICU patients. 2 reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the quality of included studies. Meta-analysis was conducted by RevMan 5.4. Results A total of 17 pieces of the literature involving 3 250 adult ICU patients were included. The statistically risk factors were BMI（MD=3.09）,24 h fluid input（MD=0.98）,mechanical ventilation（OR=3.40）,PaO₂/FiO₂（MD=-17.18）,APACHEⅡ Score（MD=4.04）,sepsis（OR=2.42）,intestinal obstruction（OR=11.67）,abdominal surgery（OR=2.10）. Conclusion Higher BMI,larger 24 h fluid input,higher APACHEⅡ Score,lower PaO₂/FiO₂,mechanical ventilation,sepsis,intestinal obstruction and abdominal surgery were independent predictors for intra-abdominal hypertension in adult ICU patients. Medical staff should dynamically assess the intra-abdominal pressure and take targeted and individualized interventions to prevent the occurrence of intra-abdominal hypertension.

Key words: Intensive Care Units, Intra-abdominal Hypertension, Risk Factors, Meta-Analysis, Evidence-Based Nursing

李志茹, 王华芬, 卢芳燕, 郑力, 董丽, 鲍瑞洁. 成人ICU患者腹内高压危险因素的Meta分析[J]. 中华急危重症护理杂志, 2023, 4(9): 792-798.

LI Zhiru, WANG Huafen, LU Fangyan, ZHENG Li, DONG Li, BAO Ruijie. Risk factors of intra-abdominal hypertension in adult ICU patients：a Meta-analysis[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(9): 792-798.

参考文献

[1] 李志茹,王华芬,卢芳燕. 危重症患者腹内压监测的最佳证据总结[J]. 中国护理管理,2022,22(5):750-754.
Li ZR,Wang HF,Lu FY.Summary of the best evidence for monitoring intra-abdominal pressure in critically ill patients[J]. Chin Nurs Manag,2022,22(5):750-754.
[2] Murphy PB,Parry NG,Sela N,et al.Intra-abdominal hypertension is more common than previously thought:a prospective study in a mixed medical-surgical ICU[J]. Crit Care Med,2018,46(6):958-964.
[3] Khot Z,Murphy PB,Sela N,et al.Incidence of intra-abdominal hypertension and abdominal compartment syndrome:a systematic review[J]. J Intensive Care Med,2021,36(2):197-202.
[4] Kirkpatrick AW,Roberts DJ,De Waele J,et al.Intra-abdominal hypertension and the abdominal compartment syndrome:updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome[J]. Intensive Care Med,2013,39(7):1190-1206.
[5] Rajasurya V,Surani S.Abdominal compartment syndrome:often overlooked conditions in medical intensive care units[J]. World J Gastroenterol,2020,26(3):266-278.
[6] Allen R,Sarani B.Evaluation and management of intraabdominal hypertension[J]. Curr Opin Crit Care,2020,26(2):192-196.
[7] Reintam Blaser A,Regli A,De Keulenaer B,et al.Incidence,risk factors,and outcomes of intra-abdominal hypertension in critically ill patients-a prospective multicenter study(IROI study)[J]. Crit Care Med,2019,47(4):535-542.
[8] 江鸿展,陈丽娟,申嘉丽,等. 老年患者失禁相关性皮炎危险因素的Meta分析[J]. 中华护理杂志,2023,58(4):471-477.
Jiang HZ,Chen LJ,Shen JL,et al.Risk factors of incontinence-associated dermatitis in elderly patients:a Meta-analysis[J]. Chin J Nurs,2023,58(4):471-477.
[9] 王宏飞,王勇强,李寅,等. 机械通气及相关因素对腹内压影响的研究[J]. 中华急诊医学杂志,2015,24(12):1430-1435.
Wang HF,Wang YQ,Li Y,et al.The impact of relevant factors in mechanical ventilation on intra-abdominal pressure in patients with ALI/ARDS[J]. Chin J Emerg Med,2015,24(12): 1430-1435.
[10] 乐健伟,朱建华. 重症患者腹内高压的危险因素及预后分析[J]. 中国急救医学,2016,36(12):1099-1102.
Le JW,Zhu JH.Risk factors for intra-abdominal hypertension and prognostic analysis among adult intensive care unit patients[J]. Chin J Crit Care Med,2016,36(12):1099-1102.
[11] 廖舒,杜贵鹏,吴希. ICU患者腹内压监测的注意事项及危险因素分析[J]. 中国卫生标准管理,2019,10(11):41-43.
Liao S,Du GP,Wu X.Precautions and risk factors analysis of intra-abdominal pressure monitoring in ICU patients[J]. China Health Stand Manag,2019,10(11):41-43.
[12] 王百鸣. ICU危重患者并发腹腔高压的危险因素和预后分析[J]. 中国乡村医药,2017,24(14):24-25.
Wang BM.Analysis of risk factors and prognosis of abdominal hypertension in critically ill patients in ICU[J]. Chin J Rural Med Pharm,2017,24(14):24-25.
[13] 谷玺,贾林, 黄耀星, 等. 危重患者腹腔内高压的发生率及其危险因素评估[J]. 中华诊断学电子杂志,2014,2(3):210-213.
Gu X, Jia L, Huang YX, et al.Incidence and risk factors of intraperitoneal hypertension in critically ill patients[J]. Chin J Diagnostics(Electr Ed),2014,2(3):210-213.
[14] 杨飞. 危重患者腹腔内高压的发生率及其影响因素[J]. 临床急诊杂志,2013,14(1):17-19.
Yang F.Incidence and risk factors of high intraabdominal pressure in critically ill patients[J]. J Clin Emerg,2013,14(1):17-19.
[15] Muturi A,Ndaguatha P,Ojuka D,et al.Prevalence and predictors of intra-abdominal hypertension and compartment syndrome in surgical patients in critical care units at Kenyatta National Hospital[J]. BMC Emerg Med,2017,17(1):10.
[16] Kim IB,Prowle J,Baldwin I,et al.Incidence,risk factors and outcome associations of intra-abdominal hypertension in critically ill patients[J]. Anaesth Intensive Care,2012,40(1):79-89.
[17] Reintam Blaser A,Parm P,Kitus R,et al.Risk factors for intra-abdominal hypertension in mechanically ventilated patients[J]. Acta Anaesthesiol Scand,2011,55(5):607-614.
[18] Pereira R,Buglevski M,Perdigoto R,et al.Intra-abdominal hypertension and abdominal compartment syndrome in the critically ill liver cirrhotic patient-prevalence and clinical outcomes. A multicentric retrospective cohort study in intensive care[J]. PLoS One,2021,16(5):e0251498.
[19] Smit M,Koopman B,Dieperink W,et al.Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU[J]. Ann Intensive Care,2020,10(1):130.
[20] Ke L,Ni HB,Sun JK,et al.Risk factors and outcome of intra-abdominal hypertension in patients with severe acute pancreatitis[J]. World J Surg,2012,36(1):171-178.
[21] deD Soler Morejón C,Tamargo Barbeito TO. Effect of mechanical ventilation on intra-abdominal pressure in critically ill patients without other risk factors for abdominal hypertension:an observational multicenter epidemiological study[J]. Ann Intensive Care,2012,2(Suppl 1):S22.
[22] Dalfino L,Sicolo A,Paparella D,et al.Intra-abdominal hypertension in cardiac surgery[J]. Interact Cardio Vasc Thorac Surg,2013,17(4):644-651.
[23] Vidal MG,Weisser JR,Gonzalez F,et al.Incidence and clinical effects of intra-abdominal hypertension in critically ill patients[J]. Crit Care Med,2008,36(6):1823-1831.
[24] Mohan S,Lim ZY,Chan KS,et al.Impact of obesity on clinical outcomes of patients with intra-abdominal hypertension and abdominal compartment syndrome[J]. Life(Basel),2023,13(2):330.
[25] Wilson A,Longhi J,Goldman C,et al.Intra-abdominal pressure and the morbidly obese patients:the effect of body mass index[J]. J Trauma Inj Infect Crit Care,2010,69(1):78-83.
[26] Rakan,Nazer,MD,et al. Intra-abdominal hypertension in obese patients undergoing coronary surgery:a prospective observational study[J]. Surgery,2019,166(6):1128-1134.
[27] Smit M,Werner MJM,Lansink-Hartgring AO,et al.How central obesity influences intra-abdominal pressure:a prospective,observational study in cardiothoracic surgical patients[J]. Ann Intensive Care,2016,6(1):99.
[28] Christensen M,Craft J.The cardio-respiratory effects of intra-abdominal hypertension:considerations for critical care nursing practice[J]. Intensive Crit Care Nurs,2018,44:53-58.
[29] Jacobs R,Wise RD,Myatchin I,et al.Fluid management,intra-abdominal hypertension and the abdominal compartment syn-drome:a narrative review[J]. Life(Basel),2022,12(9):1390.
[30] Silversides JA,Fitzgerald E,Manickavasagam US,et al.Deresuscitation of patients with iatrogenic fluid overload is associated with reduced mortality in critical illness[J]. Crit Care Med,2018,46(10):1600-1607.
[31] McNelis J. Predictive factors associated with the development of abdominal compartment syndrome in the surgical intensive care unit[J]. Arch Surg,2002,137(2):133.
[32] Regli A,Pelosi P,Malbrain MLNG.Ventilation in patients with intra-abdominal hypertension:what every critical care physician needs to know[J]. Ann Intensive Care,2019,9(1):52.
[33] Leon M,Chavez L,Surani S.Abdominal compartment syndrome among surgical patients[J]. World J Gastrointest Surg,2021,13(4):330-339.
[34] Ney JP,Moll V,Kimball EJ.Urinary catheter monitoring of intra-abdominal pressure after major abdominal surgery,a cost-benefit analysis[J]. J Med Econ,2022,25(1):412-420.
[35] Pereira B,Dorigatti A,Melek M,et al.Septic shock patients admitted to the intensive care unit with higher SOFA score tend to have higher incidence of abdominal compartment syndrome-a preliminary analysis[J]. Anaesthesiol Intensive Ther,2019,51(5):370-372.