腹内高压对门静脉压、中心静脉压影响的实验研究

目的研究腹内压升高对大鼠中心静脉压和门静脉压的影响。方法将20只成年雄性SD大鼠分别通过颈静脉插管、穿刺门静脉主干法来测定中心静脉压和门静脉压，运用氮气气腹法制作大鼠腹内高压动物模型。建立气腹后分别在0、5、10、15、20、25、30、35、40、45mmHg压力值下测得中心静脉压和门静脉压。结果中心静脉压和腹内压之间的直线回归方程为Y=2．824＋0．045X，相关系数r=0．984（P〈0．01）；门静脉压和腹内压之间的直线回归方程为Y=8．887＋0．939X，相关系数r=0．998（P〈0．01）。结论腹内压与中心静脉压和门静脉压有很好的相关性，可以根据腹内压监测中心静脉压和门静脉压的变化。     

腹内高压对门静脉压、中心静脉压影响的实验研究

目的研究腹内压升高对大鼠中心静脉压和门静脉压的影响。方法将20只成年雄性SD大鼠分别通过颈静脉插管、穿刺门静脉主干法来测定中心静脉压和门静脉压,运用氮气气腹法制作大鼠腹内高压动物模型。建立气腹后分别在0、5、10、15、20、25、30、35、40、45mmHg压力值下测得中心静脉压和门静脉压。结果中心静脉压和腹内压之间的直线回归方程为Y=2.824+0.045X,相关系数r=0.984(P<0.01);门静脉压和腹内压之间的直线回归方程为Y=8.887+0.939X,相关系数r=0.998(P<0.01)。结论腹内压与中心静脉压和门静脉压有很好的相关性,可以根据腹内压监测中心静脉压和门静脉压的变化。     

正常腹内压影响因素的临床研究

目的　探讨正常腹内压的影响因素 ,建立腹内压回归方程。方法　应用膀胱测压法测定 10 6例住院患者的腹内压 ,并对年龄、性别、身高、体重、体质指数、既往和近期腹部手术史、住院原因、合并症情况及数量等 14项因子与腹内压的关系进行分析。结果　住院患者平均腹内压为 5 .5mmHg( 1mmHg =0 .133kPa) ,范围为 0 .4～12 .8mmHg。各级体质指数相应的腹内压差异有显著性意义 (F =5 .5 5 0 ,P<0 .0 1)。男性腹内压比女性高 2 .0mmHg ,差异有显著性意义 (t=3.12 2 ,P<0 .0 1)。其他 12种因素对腹内压无明显影响 (P>0 .0 5 )。结论　正常腹内压可能受性别和体质指数影响 ,存在明显的个体差异     

腹内压增高可影响肺顺应性

已知腹内压增高可影响血流动力学、肾和肺功能损害。利用腹腔镜充气器(输注CO_2)测定腹腔内压力,由此观察肺顺应性的改变,后者可由公式[肺顺应性=潮气量/(终末吸气压-终末呼气压)ml/cmH_2O]算出。同时测定膀胱内压、胃内压和直肠内压,分别自插入膀胱的持续灌洗导尿管、插入的胃管和插入直肠反折平面     

危重症患儿腹内压监测的研究进展

介绍危重症患儿腹内压直接测量法、间接测量法（经膀胱测量法、经胃测量法）及体位、膀胱灌注量和躁动3种测量影响因素，对腹内压监测在器官移植、脓毒症、机械通气及其他危重症患儿中的应用现状及危重症患儿腹内压监测的护理要点进行综述，以期为临床探索和完善危重症患儿腹内压监测方法提供参考。     

不同体位对危重患者腹内压及腹腔灌注压的影响

【摘要】〓目的〓观察不同体位对腹内压及腹腔灌注压的影响。方法〓对2013年1月~2013年12月收治ICU的有腹内压监测适应征的78位患者分别在0°、15°、30°、45°采用测量膀胱压的方法监测腹内压,并计算腹腔灌注压。结果〓在腹内高压者,30°(21.46±3.91 mmHg, P=0.001)及45°(25.69±4.09 mmHg, P<0.001)时腹内压比0°(16.31±3.38 mmHg)时明显升高,而腹腔灌注压45°(51.92±10.05 mmHg,P=0.03)时明显低于0°(60.54±9.86 mmHg);在腹内压正常者30°(11.17±3.24 mmHg,P=0.002)及45°(15.59±4.13 mmHg, P=0.001)时腹内压比0°(7.23 ±2.14 mmHg)时明显升高,而腹腔灌注压45°(60.78±9.13 mmHg, P=0.004)时明显低于0°(71.28±8.86 mmHg)。结论〓危重病人不同体位对腹内压及腹腔灌注压有影响,床头角度越高,腹内压越高,腹腔灌注压越低,提示测量时应考虑体位的因素。     

肝移植术后腹内压监测的临床意义

目的探讨肝移植术后腹内压监测的临床意义。方法2003年9月至2005年1月,采用膀胱内压检测法间接测量腹内压,术后每天腹内压>20mmHg(1mmHg=0.133kPa)时定为腹内高压(IAH)。比较腹内高压组与正常组的原发病因、手术方式、术中相关指标及愈后。记录病人术后0～72h的腹内压、肾功能相关指标,血流动力学指标以及动脉血氧分压/吸入氧浓度比,同时记录病人的机械通气时间和术后第4天的肝功能。结果腹内高压组与正常组比较,手术时间、术中补液量、术中输血量及术后急性肾衰、呼吸衰竭的发生率差异有显著性,术后24～72h血肌酐、血尿素氮水平、每小时尿量以及心率、动脉血氧分压/吸入氧浓度比、机械通气时间也存在显著不同。结论肝移植术后并发的腹内高压对器官功能的损害是快速、多部位的,最常见的损害是肾功能与呼吸功能。重视腹内高压、术后早期腹内压的严密监测具有较重要的临床意义。     

压力支持通气时中心静脉压、膀胱内压与跨膈压的相关性研究

目的了解压力支持通气时中心静脉压（Pcvp）、膀胱内压（Pblad）的变化与食道内压（Pes）、胃内压（Pgas）变化之间的关系。方法测量基础水平PS时的Pes、Pgas、Pcvp、Pblad的值,然后PS以每次5cmH2O为量递减到0,或者到病人能够耐受的最小值,在呼吸平稳后测定Pes、Pgas、Pcvp、Pblad的值。结果笔者发现,△Pgas与△Pblad密切相关（r=0.904）,而△Pes与△Pcvp密切相关（r=0.951）。当PS改变,△Pcvp-△Pblad与跨膈压改变相比较,相关系数从0.952到0.999。结论在机械通气时△Pcvp绝对值并不一定反映ΔPes。但是,在呼吸支持水平变化时测定两个数值的变化,在一定程度上可以反映跨隔压的变化,帮助评估所需呼吸支持的力度。     

清醒和麻醉状态下大鼠膀胱测压的实验研究

目的 通过大鼠慢性膀胱炎模型研究清醒和麻醉状态下膀胱测压的特点及差异.方法 30只成年雌性SD大鼠随机分为3组,环磷酰胺(CYP)组(n=10)通过腹腔内注射CYP建立慢性膀胱炎模型;鱼精蛋白(PS)组(n=10)采用膀胱内灌注PS和脂多糖建立慢性膀胱炎模型;正常对照组(n=10).各组均分别于建模后48 h在清醒和麻醉状态下行膀胱测压.结果 清醒状态下膀胱测压结果显示,两组慢性膀胱炎模型均可见非排尿相关收缩增加伴随排尿周期的缩短.麻醉状态下膀胱测压结果显示:PS组膀胱顺应性明显下降,而CYP组则表现为不稳定膀胱.结论 麻醉状态下的膀胱测压对于研究模型动物的尿流动力学仍有其特殊的意义.     

直肠测压图中腹内压和直肠内压的关系

气囊直肠测压图可测定直肠动力学内容,包括直肠感觉、顺应性、引起排便感的粪容量和最大忍受量等,但以往的测压研究均未考虑到腹内压的因素.作者利用膀胱作为参考腹内压的场所.选择10例妇女因尿道症状作尿流动力学者作为直肠测压的研究对象,患者均无胃肠道症状或便秘.完成尿流动力学测定后,排空膀胱,仍留置导尿管.病人坐位,直肠内置入一气囊(阴茎套)双腔导尿管,以40ml/min的速度膨胀直肠,嘱病人告知何时有排便的感觉.停止直肠内充盈,在短暂的观察时间后,要求病人排空直肠气囊内的水份,分别记录膀胱内和直肠内压力,其中     

烧伤病人股静脉压与中心静脉压的相关性研究

目的探寻一种安全、易操作且能替代颈内或锁骨下静脉置管监测中心静脉压的方法。方法对 30例大面积烧伤病人同时测量中心静脉压和股静脉压 (各 2 0 4次 ) ,所得数据采用 SPSS 8.0统计软件包进行处理 ,检验股静脉压与中心静脉压的相关性 ,求出两者之间的相关系数与回归方程。结果同一病人股静脉压与中心静脉压呈直线正相关关系 (r=0 .72 0 ,P<0 .0 1) ;直线回归方程 :Y(中心静脉压 ) =0 .132 +0 .5 5 7X (股静脉压 ) ,对回归系数进行 t检验 ,P<0 .0 5。结论临床抢救大面积烧伤病人时 ,测出股静脉压的值代入回归方程 ,即可计算出该病人中心静脉压的值。     

What is normal intra-abdominal pressure?

The causes and effects of increased intra-abdominal pressure and abdominal compartment syndrome have been well documented. However, there have been no large series to determine normal intra-abdominal pressure in hospitalized patients. The purpose of this study was to determine normal intra-abdominal pressure in randomly selected hospitalized patients and to identify factors that predict variation in normal intra-abdominal pressure. A total of 77 patients were prospectively enrolled between September 1998 and July 1999. Data obtained included patient demographics (i.e., age, gender, height, weight, and body mass index), reason for hospitalization and bladder catheterization, previous and current surgical status, comorbidities, and intra-abdominal pressures. Intra-abdominal pressure readings were obtained through an indwelling transurethral bladder (Foley) catheter. Data were analyzed by analysis of variance and multiple regression analysis. There were 36 females and 41 males with a mean age of 67.7 years. Average weight, height, and body mass index were 79.6 kg, 1.70 m, and 27.6 kg/m2, respectively. Mean intraabdominal pressure was 6.5 mm Hg (range 0.2-16.2 mm Hg). Body mass index was positively related to intra-abdominal pressure (P < 0.0004). Gender, age, and medical and surgical histories did not significantly affect intra-abdominal pressure. However, using multiple regression analysis, a relationship between intra-abdominal pressure, body mass index, and abdominal surgery was discovered. Intra-abdominal pressure is related to a patient's body mass index and influenced by recent abdominal surgery. Thus, the normal intra-abdominal pressure can be estimated in hospitalized patients by using the derived equation. Knowledge of the expected intra-abdominal pressure can then by used in recognizing when an abnormally high intra-abdominal pressure or abdominal compartment syndrome exists.     

Acute intra-abdominal hypertension and "abdominal compartment syndrome"

The acute intra-abdominal hypertension causes profound physiologic abnormalities, both within and outside the abdomen. Just as in compartment syndrome in the extremities, gut mucosal ischemia begins long before clinical signs are evident, explaining the name of "abdominal compartment syndrome" given to the acute, markedly increased intra-abdominal pressure. The abdominal compartment syndrome was initially described in patients with severe abdominal injuries and massive transfusions and crystalloid infusions, caused by the closure of fascia or skin under tension, the use of bulky abdominal packs to control diffuse bleeding, the massive bowel distension and edema, and the continued bleeding into the abdominal cavity. Intra-abdominal pressure can be monitored by measuring the urinary bladder pressure with a manometer, connected to the transurethral Foley catheter, with the symphysis pubis as the zero point. A persistent elevation of the intra-abdominal pressure beyond 20-25 cmH2O, with significant respiratory, hemodynamic and renal dysfunction is an indication for abdominal decompression, before the manifestations of abdominal compartment syndrome became clinically evident. The mortality in patients with abdominal compartment syndrome is over 40%, even when adequately treated.     

Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension

OBJECTIVE: To assess the clinical utility of abdominal perfusion pressure (mean arterial pressure minus intra-abdominal pressure) as both a resuscitative endpoint and predictor of survival in patients with intra-abdominal hypertension. METHODS: 144 surgical patients treated for intra-abdominal hypertension between May 1997 and June 1999 were retrospectively reviewed. Multivariate logistic regression and receiver operating characteristic curve analysis of common physiologic variables and resuscitation endpoints were performed to determine the decision thresholds for each variable that predict patient survival. RESULTS: Abdominal perfusion pressure was statistically superior to both mean arterial pressure and intravesicular pressure in predicting patient survival from intra-abdominal hypertension and abdominal compartment syndrome. Multiple regression analysis demonstrated that abdominal perfusion pressure was also superior to other common resuscitation endpoints, including arterial pH, base deficit, arterial lactate, and hourly urinary output. CONCLUSION: Abdominal perfusion pressure appears to be a clinically useful resuscitation endpoint and predictor of patient survival during treatment for intra-abdominal hypertension and abdominal compartment syndrome.     

Abdominal compartment syndrome in patients with strangulated hernia

Background  Intestinal obstruction (IO) leads to increased intra-abdominal pressure and abdominal compartment syndrome. The purpose of this study was to investigate the characteristics of abdominal compartment syndrome in patients with IO secondary to strangulated hernia. Methods  We studied 81 consecutive unselected patients presenting complicated hernias and IO. We measured intra-abdominal pressure using the intra-vesicular pressure method. Results  Preoperative (15 min) intra-abdominal pressure was higher in patients with strangulated hernias. Postoperative (15 min) intra-abdominal pressure in both groups decreased to similar values. Intra-abdominal pressure was measured during the preoperative period in patients with strangulated hernias and during the postoperative period at 15 min (13.8 ± 6.4 mmHg), 24 h (9.8 ± 3.2 mmHg) and 48 h (7.4 ± 2.4 mmHg). Abdominal compartment syndrome developed in 47% cases with strangulated hernias with a mortality of five patients. Conclusions  Serial measurements of intra-abdominal pressure evidenced the clinical severity of strangulated hernia. Intra-abdominal pressure measurement may be used as a predictor of intestinal strangulation in patients presenting acute abdominal compartment syndrome secondary to complicated hernia. This work was read at the XVII Latin American surgical congress of FELAC (Latin American Surgical Federation) held in Santiago, Chile, 18–22 November 2007.     

Abdominal Compartment Syndrome

Compartment syndrome is a pathophysiological term, comprising a variety of tissues and organ alterations, due to a higher than normal pressure in an anatomically detached space (compartment). In the human body, areas denoted as compartments include the orbital globe, the sub and epidural space, the abdomen, pleura, pericardium, and others. Compartment syndrome was described initially in limbs. Abdominal compartment syndrome is defined as an intra-abdominal pressure above 20 mmHg with evidence of organ failure. Abdominal compartment syndrome develops when the intra-abdominal pressure rapidly reaches certain pathological values, within several hours (intra-abdominal hypertension is observed), and lasts for 6 or more hours. The key to recognizing abdominal compartment syndrome is the demonstration of elevated intra-abdominal pressure which is performed most often via the urinary bladder, and it is considered to be the “gold standard.” Multiorgan failure includes damage to the cardiac, pulmonary, renal, neurological, gastrointestinal, abdominal wall, and ophthalmic systems. The gut is the most sensitive to intra-abdominal hypertension, and it develops evidence of end-organ damage before alterations are observed in other systems. The surgical decompression of the abdomen remains the treatment of choice of abdominal compartment syndrome; this usually improves the organ changes, and is followed by one of the temporary abdominal closure techniques in order to prevent secondary intra-abdominal hypertension.     

Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome

BACKGROUND: Intra-abdominal hypertension has been recognized as a source of morbidity and mortality in the traumatized patient following laparotomy. Multiple organ dysfunction attributable to intra-abdominal hypertension has been called the abdominal compartment syndrome. The epidemiology and characteristics of these processes remain poorly defined. METHODS: Intra-abdominal pressure was measured prospectively in all patients admitted to a trauma intensive care unit over 9 months. Data were gathered on all patients with intra-abdominal hypertension. RESULTS: Some 706 patients were evaluated. Fifteen (2 per cent) of 706 patients had intra-abdominal hypertension. Six of the 15 patients with intra-abdominal hypertension had abdominal compartment syndrome. Half of the patients with abdominal compartment syndrome died, as did two of the remaining nine patients with intra-abdominal hypertension. Patients with abdominal compartment syndrome had a mean intra-abdominal pressure of 42 mmHg compared with 26 mmHg in patients with intra-abdominal hypertension only (P < 0.05). CONCLUSION: The incidence of intra-abdominal hypertension and abdominal compartment syndrome was 2 and 1 per cent respectively. Intra-abdominal hypertension did not necessarily lead to abdominal compartment syndrome, and often resolved without clinical sequelae. Abdominal compartment syndrome did not occur in the absence of earlier laparotomy. Abdominal compartment syndrome was associated with a marked increase in intra-abdominal pressure (above 40 mmHg).     

Intra-abdominal hypertension and the abdominal compartment syndrome

The pressure within the abdominal cavity is normally little more than atmospheric pressure. However, even small increases in intra-abdominal pressure can have adverse effects on renal function, cardiac output, hepatic blood flow, respiratory mechanics, splanchnic perfusion and intracranial pressure. Although intra-abdominal pressure can be measured directly, this is invasive and bedside measurement of intra-abdominal pressure is usually achieved via the urinary bladder. This cheap, easy approach has been shown to produce results that correlate closely with directly measured abdominal pressures. Significant increases in intra-abdominal pressure are seen in a wide variety of conditions commonly encountered in the intensive care unit, such as ruptured aortic aneurysm, abdominal trauma and acute pancreatitis. Abdominal compartment syndrome describes the combination of increased intra-abdominal pressure and end-organ dysfunction. This syndrome has a high mortality, most deaths resulting from sepsis and multi-organ failure. Detection of abdominal compartment syndrome requires close surveillance of intra-abdominal pressure in patients thought to be at risk of developing intra-abdominal hypertension. The only available treatment for established abdominal compartment syndrome is decompressive laparotomy. Prevention of abdominal compartment syndrome after laparotomy by adoption of an open abdomen approach may be preferable in the patient at significant risk of developing intra-abdominal hypertension, but this has not been demonstrated in any large trials. Most surgeons prefer to adopt a 'wait and see' policy, only intervening when clinical deterioration is associated with a significant increase in intra-abdominal pressure.     

Intra-abdominal hypertension and abdominal compartment syndrome

BACKGROUND: The effects of increased intra-abdominal pressure in various organ systems have been noted over the past century. The concept of abdominal compartment syndrome has gained more attention in both trauma and general surgery in the last decade. This article reviews the current understanding and management of intra-abdominal hypertension and abdominal compartment syndrome. METHODS: Relevant information was gathered from a Medline search of the English literature, previous review and original articles, references cited in papers, and by checking the latest issues of appropriate journals. RESULTS AND CONCLUSION: Akin to compartment syndrome in extremities, the pathophysiological effects of increased intra-abdominal pressure developed well before any clinical evidence of compartment syndrome. These effects include cardiovascular, pulmonary, renal and intracranial derangement, reduction of intestinal and hepatic blood flow, and reduction of abdominal wall compliance. Although abdominal compartment syndrome is more commonly noted in patients with abdominal trauma, it is now evident that non-trauma surgical patients could also develop the condition. Early initiation of treatment for intra-abdominal hypertension is currently advocated in view of the possibility of subclinical progress to the full-blown abdominal compartment syndrome.