放腹水对肝硬化患者腹腔内压及肾脏血流灌注的影响

肝脏 ›› 2023, Vol. 28 ›› Issue (1): 50-54.

放腹水对肝硬化患者腹腔内压及肾脏血流灌注的影响

郭贺冰, 王雪梅, 刘景院

100015 首都医科大学附属北京地坛医院重症医学科(郭贺冰,刘景院),超声科(王雪梅)

收稿日期:2022-07-02 出版日期:2023-01-31 发布日期:2023-02-21
通讯作者: 刘景院,Email:dtyyicu@ccmu.edu.cn
基金资助:
北京市医院管理中心扬帆计划 ( ZYLX201802 );首都医科大学附属北京地坛医院院内科研基金“育苗计划”项目(DTYM201802)

Effect of ascites discharge on intra-abdominal pressure and renal perfusion in patients with cirrhosis

GUO He-bing¹, WANG Xue-mei², LIU Jing-yuan¹

1. Department of Critical Care Medicine,Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
2. Doppler Ultrasonic Department, Beijing Ditan Hospital, Capital Medical University,Beijing 100015, China

Received:2022-07-02 Online:2023-01-31 Published:2023-02-21
Contact: LIU Jing-yuan, Email: dtyyicu@ccmu.edu.cn

摘要/Abstract

摘要： 目的探讨肝硬化腹水患者的超声肾脏血流灌注指标特点、腹腔内压与肾阻力指数的关系,以及放腹水对腹腔内压、全身血流动力学和肾血流灌注指标的影响。方法纳入肝硬化腹水伴腹内高压患者21例。应用超声彩色多普勒技术测定肾脏血流灌注指标,采用腹腔穿刺直接测压法来测定腹腔压力。分别测定放腹水前、累计放腹水2500 mL、累计放腹水5000 mL、累计放腹水7500 mL时的腹腔内压、超声肾脏血流相关指标和全身血流动力学指标。采用Pearson相关性分析腹腔内压与肾阻力指数的相关性,采用自身对照设计分析大量放腹水对全身血流动力学和肾脏血流灌注的影响。结果本组肝硬化合并腹水患者存在明显的腹腔高压,腹腔内压为18(15.5,21)cmH₂O;肾动脉阻力指数(RI)普遍增高,RI为0.727(0.72,0.755);腹腔内压与肾阻力指数存在中等相关性(r=0.491,P<0.01)。放腹水能够显著降低腹腔内压:放腹水前腹内压18(15.5,21)cmH₂O、累计放腹水7500 mL时腹内压12(9.5,13.5)cmH₂O(H=26.584,P<0.01)。随着腹腔内压的下降,患者的平均动脉压有下降的趋势:放腹水前平均动脉压81(77,90)mmHg,累计放腹水7500 mL时平均动脉压76(75,81)mmHg(H=8.767,P=0.033)。随着腹内压的下降,肾阻力指数显著下降:放腹水前平均RI为0.727(0.72,0.755),累计放腹水7500 mL时RI为0.641(0.623,0.66)(H=64.104,P<0.01)。结论腹腔内压与肾阻力指数存在相关性,放腹水可改善肝硬化腹水患者的腹腔高压和肾动脉阻力指数。

关键词: 放腹水, 肝硬化, 腹腔内压, 超声, 肾脏血流灌注

Abstract: Objective To investigate the characteristics of ultrasonic renal perfusion indexes in patients with cirrhotic ascites and relationship between intra-abdominal pressure and renal resistance index. To investigate the influence of ascites discharge on intra-abdominal pressure, systemic hemodynamics and renal perfusion. Methods Patients with cirrhotic ascites and intra-abdominal hypertension were included, with an average age of 18-70 years. Patients with chronic renal failure and other causes that interfered with abdominal ultrasonography were excluded. A total of 21 cases were included in the study. Color Doppler ultrasonography was used to measure the renal blood perfusion index. Direct peritoneal puncture manometry was used to measure peritoneal pressure. Intra-abdominal pressure, systemic hemodynamic indexes, and renal blood perfusion parameters were recorded and analyzed at 4 time nodes: before discharging ascites, cumulative release of ascites 2500 ml, 5000ml and 7500ml, respectively. Pearson correlation analysis was used to analyze the relationship between intra-abdominal pressure and the renal resistance index. Self-control design was used to analyzed the effect of massive ascites drainage on systemic hemodynamics and renal perfusion. Results Abdominal hypertension was obvious in patients with cirrhosis and ascites. The median intraperitoneal pressure was 18 (15.5-21) cmH₂O. Renal artery resistance index (RI) generally increased, the median intraperitoneal RI was 0.727 (0.72-0.755). There was a moderate correlation between the intra-abdominal pressure and the renal resistance index (r=0.491, P＜0.001). Intraperitoneal pressure could be significantly reduced after ascites discharge. The median intraperitoneal pressure before discharging ascites and cumulatively discharging ascites 7500 mL were 18 (15.5-21) cmH₂O and 12 (9.5-13.5) cmH₂O, H=26.584, P＜0.001. As intra-abdominal pressure decreases, there was a downward trend for the mean arterial pressure. The mean arterial pressure before discharging ascites and cumulatively discharging ascites 7500 mL were 81 (77-90) mmHg and 76 (75-81) mmHg, H=8.767, P=0.033. The renal resistance index decreased significantly with the decrease of intra-abdominal pressure. The average RI before discharging ascites and cumulatively discharging ascites 7500 mL were 0.727 (0.72-0.755) and 0.641 (0.623-0.66), H=64.104, P＜0.001.Conclusion There is a correlation between intra-abdominal pressure and the renal resistance index. Discharging ascites can improve peritoneal hypertension and the renal artery resistance index in cirrhotic patients with ascites.

Key words: Drain ascites, Liver cirrhosis, Intra-abdominal pressure, Doppler ultrasound, Renal perfusion

郭贺冰, 王雪梅, 刘景院. 放腹水对肝硬化患者腹腔内压及肾脏血流灌注的影响[J]. 肝脏, 2023, 28(1): 50-54.

GUO He-bing, WANG Xue-mei, LIU Jing-yuan. Effect of ascites discharge on intra-abdominal pressure and renal perfusion in patients with cirrhosis[J]. Chinese Hepatolgy, 2023, 28(1): 50-54.

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