膀胱灌注量对膀胱压和腹内压影响的临床研究

目的 探讨不同膀胱灌注量对膀胱压（IVP）和腹内压（IAP）的影响,探寻应用膀胱压间接反映腹内压的最佳膀胱灌注量,以指导腹腔室隔综合征（ACS）的早期诊断和治疗.方法 选择腹腔镜手术病人61例进行前瞻性自身对照研究.手术时,设定腹内压为15 mmHg,于膀胱灌注量为0、10、20、30、50 ml时,取腋中线髂嵴水平为零点测定膀胱压.结果 膀胱灌注量为10ml并取腋中线髂嵴水平为零点时,膀胱压与腹内压（15mmHg）最接近（P＞0.05）,为（15.08 ±0.89） mmHg.而其余灌注量所测得的膀胱压与腹内压有显著差异（P ＜0.001）.结论 当膀胱灌注量为10ml并取腋中线髂嵴水平为零点时,膀胱压能准确反映腹内压.     

自制一体化膀胱测压仪与传统尿动力膀胱测压导管在腹腔间隔室综合征诊断中的应用

目的:探讨自制一体化膀胱测压仪与传统尿动力膀胱测压导管在腹腔间隔室综合征(ACS)诊断中的应用效果。方法:选取2021年3月—2021年10月需行膀胱压监测的80例病人为研究对象,所有病人均分次采用传统的间接测定腹腔压法(传统法)和自制一体化膀胱测压仪(改良法)监测膀胱内压。记录两种方法测量膀胱测压的操作时间、测压数值及所需费用,并记录两种方法ACS诊断率、导管排气便捷率和尿路感染发生率;评估护理人员对两种不同膀胱测压法的满意度。结果:改良法与传统法膀胱压测量值比较差异无统计学意义(P>0.05);但改良法操作时间均短于传统法,差异有统计学意义(P<0.05);两组ACS诊断率、尿路感染发生率比较差异无统计学意义(P>0.05);改良法导管排气便捷率为98.75%(79/80),高于传统法的85.00%(68/80),差异有统计学意义(P<0.05);护士对改良法满意度为92.50%(37/40),高于传统法的67.50%(27/40),组间比较差异有统计学意义(P<0.05)。结论:自制一体化膀胱测压仪与传统的膀胱测压的测量值无差异,可准确地反映腹内压且操作简便、治疗费用低,是ACS早期诊断可靠的方法。     

体位对经膀胱内途径间接测定腹内压的影响

目的观察体位对经膀胱内途径间接测定腹内压的影响.方法按腹腔内压力(intra-abdominal pressure,IAP)分级对2011年5月—2012年1月ICU收治的12例腹内压增高患者在平卧位(0°)采用经膀胱内途径间接测定 IAP,共72例次,分别取15°、30°体位下观察IAP的变化情况.结果不同体位下IAP值比较差异有统计学意义,15°、30°体位下IAP值与平卧位IAP值相比较,差异有统计学意义(P<0.01),15°、30°体位下IAP值较0°IAP值分别增加(1.94±0.49)、(5.02±0.88)mmHg(1 mmHg=0.133 kPa),抬高体位和IAP增加呈正相关(r=0.87,P<0.01).结论抬高体位使患者IAP增加,仰卧位测量的IAP可能低估了床头抬高的患者的真实IAP,应引起重视.     

膀胱内注入不同液量对危重患者腹内压测量的影响

目的探讨不同的膀胱内注入液量对危重患者腹内压(intra-abdominal pressure,IAP)测量值的影响。方法采取前瞻性队列研究,将我院重症监护病房的40例具有腹腔高压危险因素患者,均采取仰卧位,通过连续注入膀胱内不同液量(注入液量25 ml和50 ml),测得各注入液量下的IAP值并进行分析比较。结果 IAP25ml值为8~21(13.95±3.15)mmHg,IAP50ml值为9~21(14.90±3.46)mmHg,差异有统计学意义(P0.0001)。IAP25ml和IAP50ml平均差值为0.95 mmHg[95%可信区间(CI)0.60~1.30,上下限分别是3.1和-1.2 mmHg],IAP50ml与IAP25ml间的Spearman秩相关系数为0.924(95%CI 0.860~0.959,P0.0001)。结论仰卧位时膀胱内注入液量50 ml与25 ml比较,IAP测量值偏高,推荐膀胱内注入液量以不超过25 ml为宜。     

小儿腹内压测量的最佳膀胱容量

成人和较大体重的患儿，已被证实向膀胱内注入50ml液体能够测出其准确的腹内压。对较小的患儿测量腹内压应注入多少液体鲜有文献报道，注入不适当的液体量能够影响腹内压的准确性，从而影响治疗干预的效果。     

经膀胱内途径间接测定腹内压的影响因素分析

目的 探讨经膀胱内途径间接测定腹内压的影响因素。 方法 选取2009年3月-2016年3月在ICU收治的412例腹腔高压征患者作为研究对象,采用膀胱内途径在平卧位、半卧位(15°、30°、45°)、端坐位、俯卧位、左侧卧位、右侧卧位和中凹位(头脚各抬高15°)测定患者腹腔内压力(intra-abdominal pressure, IAP)并采用多元线性回归分析腹内压测量值的影响因素。 结果 不同性别、体位、体质量指数(BMI)、机械通气流量,其IAP差异有统计学意义;多元线性回归分析显示,性别、BMI、机械通气流量是IAP的影响因素。 结论 经膀胱内途径间接测定腹内压时体位、性别、BMI和机械通气流量对IAP测量结果有影响,在测定腹内压过程中,应选择适宜的测定条件。     

充盈性膀胱测压与交感皮肤反应同步检查评价膀胱感觉功能

目的探讨充盈性膀胱测压(FC)与交感皮肤反应(SSR)同步检测在临床评价膀胱感觉功能中的价值。方法对15名健康成年男性分别行常规充盈性膀胱测压检查(常规FC)和充盈膀胱测压与交感皮肤反应同步检查(FC-SSR同步检查)。比较两种检查方法测得的初始尿意容量(FDC)、最大膀胱测压容量(MCC)及FDC/MCC值。结果常规FC检查FDC为(193.8±36.9)ml,FDC/MCC为(58.9±8.03),明显小于FC-SSR同步检查测得FDC(233.9±30.3)ml,FDC/MCC(69.4±2.92)(P<0.01)。结论 FC-SSR同步检查能较客观反映膀胱感觉功能。     

简易膀胱测压装置的研制及应用

膀胱压与腹内压非常接近,且测量较为方便,在临床上可用膀胱压代替腹内压[1].通过监测膀胱压间接了解闭合性腹部外伤患者腹腔内出血情况,提前干预腹腔内出血导致的循环、呼吸、肾脏、胃肠、颅脑等一系列的生理功能障碍,膀胱压的变化与腹部闭合性损伤严重程度存在相关性,可及时判断是否需行剖腹探查手术.     

一种简易腹压测量装置的制作及应用

腹压(intra-abdominal pressure,IAP)是指膀胱周围腹腔压力,正常情况下为零或稍低于大气压.传统测量腹围可粗略了解病人腹腔压力的变化.近年来,随着重症监护技术的发展,腹内压的测量方法分直接测量和间接测量两种.直接测量法带有损伤性,一般慎用.间接测量法指通过测量胃、膀胱、直肠内的压力来反映腹内压.     

腹腔灌注压监测在ICU中的应用及效果观察

目的:探讨腹腔灌注压(APP)监测在ICU的应用效果.方法:采用经膀胱测压法测腹内压(IAP),以平均动脉压(MAP)-IAP计算APP,比较存活组与死亡组APP的差异及APP与IAP、多脏器功能衰竭(MODS)、APACH Ⅱ的相关性.结果:死亡组APP(67.2±18.4)mm Hg(1 mm Hg=0.133 kPa),存活组(88.5±17.1)mm Hg,两组比较差异有统计学意义(P<0.05),IAP与APP之间无相关性,APP与MODS、APACHⅡ显著负相关.结论:APP对于预测腹腔间隙综合征较腹内压具有更高的敏感性和特异性,是一个独立的预后指标.多脏器功能衰竭患者APP降低,预后更差.     

Saline volume in transvesical intra-abdominal pressure measurement: enough is enough

Objective The objective was to determine the minimum volume of instillation fluid for intra-abdominal pressure (IAP) measurement, and to evaluate the effect of instillation volume on transvesically measured IAP. Design Prospective cohort study Setting Twenty-two-bed surgical ICU of the Ghent University Hospital Patients and participants Twenty patients at risk of intra-abdominal hypertension (IAH). Interventions Transvesical IAP measurement using volumes from 10 to 100 ml. Minimal volume at which an IAP was measured was recorded (IAP_min), as well as IAP at 50 and 100 ml of instillation volume (IAP₅₀ and IAP₁₀₀). The percentage difference for IAP₅₀ and IAP₁₀₀ was calculated. Measurements and results The minimal volume for IAP measurement was 10 ml in all patients. Mean IAP_min was 12.8 mmHg (± 4.9), mean IAP₅₀ 15 mmHg (± 4.5) and mean IAP₁₀₀ 17.1mmHg (± 4.7). The mean percentage difference for IAP₅₀ was 21% (± 17%), and 40% (± 29%) for IAP_100. Twelve patients were categorised as suffering from IAH when 10 ml of saline was used for IAP measurement, increasing to 15 and 17 patients respectively when using 50 and 100 ml. In patients with IAH, there was a significant correlation between the duration of bladder drainage and percentage difference for IAP₁₀₀ (Pearson correlation coefficient 0.60, p = 0.03). Conclusions Using 50 or 100 ml of saline for IAP measurement in critically ill patients results in higher IAP values compared with the use of 10 ml, and possibly, in overestimation of the incidence of intra-abdominal hypertension. This work was presented at the annual meeting of the European Society of Intensive Care Medicine, Amsterdam 10–13 October 2005     

Reproducibility of bladder pressure measurements in critically ill patients

Objective Intra-abdominal hypertension is an independent cause of multiorgan failure and directly effects other physiological measurements, making it an important factor in the management of critically ill patients, but no clinical studies have investigated the reproducibility of intra-abdominal pressure (IAP) measurement to ensure diagnostic accuracy. This study evaluated the intraobserver and interobserver variability of bladder pressure measurements. Design and setting Prospective, observational study in a university-based adult surgical intensive care unit. Patients Critically ill patients undergoing intra-abdominal pressure readings, measured by nursing staff. Measurements and results The study compared patient IAP measurements obtained by the same nurse (intraobserver variation) and between two different nurses (interobserver variation) in critical care patients with clinical indications for IAP monitoring. Data related to the nursing technique and performance were observed and collected for each IAP measurement obtained. Good correlation of bladder pressure measurements between the same and different individuals was found. Intraobserver and interobserver Pearson's correlations for measured IAP were 0.934 and 0.950, respectively. A unit protocol for IAP measurement standardization was modified based on observational data collected. Conclusions Intra-abdominal pressure can be accurately and reliably measured in critically ill patients by utilizing a standardized measurement device combined with a standardized clinical protocol.     

Effect of bladder volume on measured intravesical pressure: a prospective cohort study

Introduction  

Correct bedside measurement of intra-abdominal pressure (IAP) is important. The bladder method is considered as the gold standard for indirect IAP measurement, but the instillation volumes reported in the literature vary substantially. The aim of this study was to evaluate the effect of instillation volume on intra-bladder pressure (IBP) as an estimation for IAP in critically ill patients.     

Validation of the urine column measurement as an estimation of the intra-abdominal pressure

Objective  To evaluate the efficacy of the urine column (UC) measurement compared to the intra-vesicular pressure (IVP) measurement as an estimation of intra-abdominal pressure (IAP) in patients with IAP up to 30 mmHg. Methods  Fifteen patients undergoing a laparoscopic cholecystectomy were studied. All patients were catheterized. IVP measurements were performed using a pressure transducer connected to the culture aspiration port. UC measurements were done by holding up the tubing against a measuring rod. The symphysis pubis was used as the zero-reference. IAP was raised from 0 to 30 mmHg using increments of 5 mmHg, during which first the IVP and then UC measurement series were recorded end-expiratory. Fifty and 100 ml of saline were used as a priming volume. Results  The IVP and UC measurements showed a significant correlation with IAP. Comparing IVP and UC showed a correlation of 0.91 (p < 0.001) for 50 ml and 0.87 (p < 0.001) for 100 ml of saline as a priming volume. Using 50 ml of saline, UC was 0.68 mmHg higher than IVP (95% CI −7.21 to +5.85 mmHg). For 100 ml of saline, UC was 1.23 mmHg lower than IVP (95% CI −7.41 to +9.87 mmHg). Conclusion  UC measurement shows significant correlation to IVP measurement as an estimation of the IAP. Further study needs to be done to conclude whether UC measurement is a reliable clinical alternative to IVP measurement.     

Comparison of indirect methods of measuring intra-abdominal pressure in children

Objective To determine the most accurate indirect method of measuring intra-abdominal pressure (IAP) in children.Design and setting Single-centre, prospective, clinical study in a 23-bed specialist paediatric intensive care unit in Australia.Patients and participants 20 children admitted to paediatric intensive care with a peritoneal dialysis catheter in situ following congenital cardiac surgery.Interventions IAP was measured directly via the peritoneal dialysis catheter and by intragastric manometry via an indwelling nasogastric tube, and by intravesical manometry via an indwelling transurethral urinary catheter, using volumes of 0, 1, 3 and 5 ml/kg body weight of sterile saline instilled into the bladder.Measurements and results Across the range of IAPs of 1–8 mmHg the Bland-Altman method for assessing agreement between two methods of clinical measurement showed bladder pressure measured via the urinary catheter with 1 ml/kg body weight of saline instilled to be the most accurate indirect measurement technique, tending to give pressures between 0.07 and 1.23 mmHg higher than the direct measurement (95% CI for bias). Measuring bladder pressure with either no saline instilled or more saline per kilogram body weight instilled was less accurate over the same range of pressures, as was measuring the gastric pressure.Conclusions The most accurate indirect method of measuring IAP in children over the normal range of IAPs involves measuring bladder pressure via a transurethral urinary catheter with 1 ml/kg body weight of sterile saline instilled into the bladder.     

Transvesical intra-abdominal pressure measurement using minimal instillation volumes: how low can we go?

Objective To determine the minimal instillation volume at which an intra-abdominal pressure (IAP) curve can be obtained and to compare this with the IAP measured at 20 ml instilled volume. Design and setting Prospective cohort study in the Intensive Care Unit of Ghent University Hospital. Patients Twenty-five critically ill sedated and ventilated patients at risk for intra-abdominal hypertension (IAH). Interventions IAP was measured transvesically using a custom-designed IAP monitoring set. Measurement was started without any additional instillation of saline and was continued at 1-ml increments up to 10 ml. Finally, IAP was measured with 20 ml instillation volume. Measurements and results After each instillation an “oscillation test” was performed. The minimal volume at which the oscillation test was positive was recorded. These values were compared to the IAP obtained using 20 ml saline (IAP_20 ml). At 2 ml installed saline volume an oscillation curve could be obtained in all patients. Mean IAP_2 ml was 11.2 ± 3.2 mmHg, IAP_10 ml 11.4 ± 3.7 mmHg, and IAP_20 ml 11.7 ± 3.2 mmHg. In four patients (16%) there was a clinically significant difference of 2 mmHg or more between IAP_2 ml and IAP_20 ml. The mean difference between IAP_20 ml and IAP_2 ml was 0.60 ± 0.91 mmHg (95% CI 0.22–0.98). Conclusions In this sample of patients at risk for IAH 2 ml saline was sufficient for IAP signal transduction. Higher volumes for transvesical IAP measurement resulted in higher pressure readings in some patients.     

Evaluation of two novel methods for the direct and continuous measurement of the intra-abdominal pressure in a porcine model

Objective Intravesical bladder pressure (IVP) measurement is considered to be the gold standard for the assessment of intra-abdominal pressure (IAP). However, this method is indirect, discontinuous, and potentially infectious and relies on a physiological bladder function. This study evaluated two novel methods for direct, continuous IAP measurement.Design and setting Experimental study in an animal research laboratory.Subjects 18 male domestic pigs.Interventions CO₂ was insufflated to increase the IAP to 30 mmHg for 18 and 24 h in six animals each. Another six animals served as controls. A piezoresistive (PRM) and an air-capsule (ACM) pressure measurement probe were placed intra-abdominally and of IAP was measured every 1 h (PRM/ACM) or every 2 h (IVP). The mean difference between insufflator readings and IAP values and limits of agreement (mean difference ±2 SD) were calculated.Measurements and results In the presence of applied pressure IVP and PRM remained significantly below insufflator readings while ACM values showed no difference. Mean difference (and limits of agreement) were 4.5 (–2.1 to 11.1 mmHg), 1.6 (–8.0 to 11.2 mmHg), and 0.5 (–4.5 to 5.4 mmHg) for IVP, PRM, and ACM. The mean measurement-to-measurement drift of the ACM values was 9.0±10.2 mmHg.Conclusions In this model agreement of PRM and ACM with insufflator readings was comparable to IVP. As both methods may be advantageous regarding continuous straightforward measurement of IAP, the employment in further experimental and clinical investigations is suggested.This research work was supported by the Deutsche Forschungsgemeinschaft and the Medical Service of the German Armed Forces.     

Intra-abdominal hypertension in the critically ill: Interrater reliability of bladder pressure measurement

Purpose

Intra-abdominal hypertension is frequently underdiagnosed and defined by intra-abdominal pressure (IAP) 12 mm Hg or higher. Increasing IAP may compromise organ viability and culminate in abdominal compartment syndrome. Bladder pressure measurement is a surrogate for IAP, but measurement properties are unknown in the intensive care unit. Our primary objective was to assess the agreement of bladder pressure measurements in critically ill patients.

Methods

We conducted an observational study examining the correlation of measurement variability of bladder pressure. Four raters (2 nurses and 2 physicians) measured IAP. Patient's age, Acute Physiology and Chronic Health Evaluation II, body mass index, mechanical ventilation parameters, and demographics were collected.

Results

Fifty-one patients had bladder pressures measured in quadruplicate, producing 204 measurements. Among 51 patients, the mean age was 61.9 years, Acute Physiology and Chronic Health Evaluation II was 23.8, and body mass index was 27.8 kg/m². The average bladder pressure was 12.4 (SD, ± 6.2) mm Hg. The interrater agreement by intraclass correlation coefficient was 0.745 (95% confidence interval [CI], 0.637-0.825), 0.804 (95% CI, 0.684-0.882), and 0.626 (95% CI, 0.428-0.767) among all raters, physicians, and nurses, respectively.

Conclusions

Agreement on bladder pressure was high among 4 clinicians and were not significantly different between physicians and nurses. Given that medical/surgical treatments are considered on bladder pressure values, understanding their reliability is essential to monitor critically ill patients.