嚴重燒傷病人腹內壓預測因子探討

Exploring on Predictive Factors of Intra-Abdominal Pressure in Severe Burn Patients

目的：嚴重症燒傷病人在急性期有大量輸液治療的需求，由於輸液及治療的過程，可能產生腹內壓升高的風險。此研究分析造成腹內高壓的預測因子，以提供臨床監測之參考。
方法：以病歷回溯方式，分析30位嚴重燒傷病人於燒傷中心腹內壓監測、點滴輸液量、尿液輸出量，以百分比、平均數、標準差進行病人基本屬性分析，並分析影響腹內壓變化之預測。
結果：以回歸分析進行探討，顯示住院第一天每小時輸液越多則腹內壓越高(b =0.436, p = 0.007)，住院後前三天平均尿液量輸出越少則腹內壓越高，(b =–0.415, p =0.010)，整體解釋變異量34.9%。
結論：點滴輸液量及尿液輸出量可以協助預測腹內壓變化，建議嚴重燒傷重症病人入院應將IAP納入常規之監測，以防範腹內壓增高所造成的合併症，使病人獲得更優質之重症照護。

Objective: Patients with severe burns are at risk for intra-abdominal hypertension (IAH) due to fluid resuscitation and management requirements. This study identified factors that could predict IAH through a retrospective analysis of medical records to thereby provide a basis for intra-abdominal pressure (IAP) monitoring.
Methods: The medical records (including demographic data and fluid resuscitation and IAP monitoring data) of a sample of patients with severe burns were retrospectively analyzed through regression analysis, and the factors predicting IAP changes were identified.
Results: The results revealed that on the first day of hospitalization, undergoing more infusions per hour increased the level of IAP (beta coefficient = 0.436, p = 0.007). Three days before hospitalization, a lower average urine output was associated with a higher IAP, (beta coefficient =−0.415, p = 0.010), and the total variance explained was 34.9%.
Conclusion: Various inputs and outputs should be integrated with an IAP monitoring framework to enable the early prediction and prevention of IAP changes.