目的 研究腹內(nèi)壓監(jiān)測在肝移植患者中應(yīng)用的臨床意義。方法 對(duì)2002年9月至2009年1月期間143例肝移植術(shù)后患者進(jìn)行了腹內(nèi)壓監(jiān)測。 將腹內(nèi)壓大于10 cm H2O (1 cm H2O=0.098 kPa) 定為腹內(nèi)高壓組，其中10＜腹內(nèi)壓≤15 cm H2O為Ⅰ級(jí)，15＜腹內(nèi)壓≤25 cm H2O為Ⅱ級(jí)，25＜腹內(nèi)壓≤35 cm H2O為Ⅲ級(jí)，35 cm H2O以上為Ⅳ級(jí)。 所有病例連續(xù)7 d測量腹內(nèi)壓并記錄循環(huán)、呼吸及腎功能相關(guān)生理指標(biāo)，將腹內(nèi)高壓組不同級(jí)別者的循環(huán)、呼吸和腎功能分別與腹內(nèi)壓正常組進(jìn)行比較。 結(jié)果 肝移植術(shù)后出現(xiàn)腹內(nèi)高壓者45例(31.5%)，其中Ⅰ級(jí)18例、Ⅱ級(jí)13例、Ⅲ級(jí)11例、Ⅳ級(jí)3例。腹內(nèi)高壓組中所有級(jí)別者的SCr和BUN與腹內(nèi)壓正常組比較均明顯升高，而PaO2則表現(xiàn)為下降，差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05，P＜0.01)； 心率只在Ⅱ、Ⅲ、Ⅳ級(jí)的腹內(nèi)高壓組有顯著升高，呼吸頻率和PaCO2只在Ⅲ、Ⅳ級(jí)的腹內(nèi)高壓組有顯著升高，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05，P＜0.01)。結(jié)論 肝移植術(shù)后腹內(nèi)高壓并不少見，對(duì)呼吸、循環(huán)及腎功能均可造成影響，術(shù)后常規(guī)進(jìn)行定期的腹內(nèi)壓檢測是必要的，對(duì)術(shù)后實(shí)施適時(shí)適度的醫(yī)療干預(yù)具有指導(dǎo)作用。
引用本文： 張誠華,葛亮,何謙. 腹內(nèi)壓監(jiān)測在肝移植術(shù)患者中的應(yīng)用研究. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(12): 982-986. doi: 復(fù)制
| 1. | Grubben AC, van Baardwijk AA, Broering DC, et al. Pathophysiology and clinical significance of the abdominal compartment syndrome [Ｊ]. Zentralbl Chir, 2001； 126(8): 605-609. |
| 2. | Hong JJ, Cohn SM, Perez JM, et al. Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Br J Surg, 2002； 89(5): 591-596. |
| 3. | Moore AF, Hargest R, Martin M, et al. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Br J Surg, 2004； 91(9): 1102-1110. |
| 4. | Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement： validity and methodology [Ｊ]. J Trauma, 2001； 50(2): 297-302. |
| 5. | 萬勇, 葛穎, 王大慶, 等. 膀胱壓、胃內(nèi)壓與腹內(nèi)壓的相關(guān)性研究 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2003； 10(4): 383-384. |
| 6. | 黎介壽. 急性腹腔間室綜合征及其護(hù)理 [Ｊ]. 中華護(hù)理雜志, 2007； 42(3): 209-211. |
| 7. | Sabiston Ed. Textbook of surgery [M]. 17th eds. Philadelphia: Saunders. 2004: 628-630. |
| 8. | Saggi BH, Sugerman HJ, Ivatury RR, et al. Abdominal co-mpartment syndrome [Ｊ]. J Trauma, 1998； 45(3): 597-609. |
| 9. | 吳在德. 肝疾病 [A]. 見: 吳在德主編. 外科學(xué) [M]. 第5版. 北京: 人民衛(wèi)生出版社, 2000: 582-585. |
| 10. | Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance [Ｊ]. Arch Surg, 1995； 130(5): 544-547. |
| 11. | Sieh KM, Chu KM, Wong J. Intra-abdominal hypertension and abdominal compartment syndrome [Ｊ]. Langenbecks Arch Surg, 2001； 386(1): 53-61. |
| 12. | 王大慶, 葛穎, 龔宗煉, 等. 不同水平腹內(nèi)壓對(duì)豬血流動(dòng)力學(xué)和氧代謝指標(biāo)的影響 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008； 15(5): 333-336. |
| 13. | Joynt GM, Ramsay SJ, Buckley TA. Intra-abdominal hypertension-implications for the intensive care physician [Ｊ]. Ann Acad Med Singapore, 2001； 30(3): 310-319. |
| 14. | Schachtrupp A, Graf J, Tons C, et al. Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension [Ｊ]. J Trauma, 2003； 55(4): 734-740. |
| 15. | Blevins DV, Khanduja KS. Abdominal compartment syndr-ome with massive lower-extremity edema caused by colonic obstruction and distention [Ｊ]. Am Surg, 2001； 67(5): 451-453. |
| 16. | Yokoyama Y, Alterman DM, Sarmadi AH, et al. Hepatic vascular response to elevated intraperitoneal pressure in the rat [Ｊ]. J Surg Res, 2002； 105(2): 86-94. |
| 17. | Nakatani T, Sakamoto Y, Kaneko I, et al. Effects of intra-abdominal hypertension on hepatic energy metabolism in a rabbit model [Ｊ]. J Trauma, 1998； 44(3): 446-453. |
| 18. | Loi P, De Backer D, Vincent JL. Abdominal compartment syndrome [Ｊ]. Acta Chir Belg, 2001； 101(2): 59-64. |
| 19. | Doty JM, Saggi BH, Blocher CR, et al. Effects of increased renal parenchymal pressure on renal function [Ｊ]. J Trauma, 2000； 48(5): 874-877. |
| 20. | Doty JM, Saggi BH, Sugerman HJ, et al. Effect of increased renal venous pressure on renal function [Ｊ]. J Trauma, 1999； 47(6): 1000-1003. |
| 21. | Sugrue M, Jones F, Deane SA, et al. Intra-abdominal hypertension is an independent cause of postoperative renal impairment [Ｊ]. Arch Surg， 1999； 134(10): 1082-1085. |
| 22. | Hunter JD, Damani Z. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Anaesthesia, 2004； 59(9): 899-907. |
| 23. | Biancofiore G, Bindi L, Romanlli AM, et al. Renal failure and abdominal hypertension after liver transplantation: determination of critical intra-abdominal pressure [Ｊ]. Liver Transpl, 2002； 8(12): 1175-1181. |
| 24. | Biancofiore G, Bindi ML, Romanelli AM, et al. Postoperative intra-abdominal pressure and renal function after liver transplantation [Ｊ]. Arch Surg， 2003； 138(7): 703-706. |
| 25. | 楊新平, 姜洪池. 腹腔內(nèi)高壓與腹腔間室綜合征 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2002； 9(6): 451-453. |
| 26. | Offner PJ, de Souza AL, Moore EE, et al. Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma [Ｊ]. Arch Surg, 2001； 136(6): 676-681. |
- 1. Grubben AC, van Baardwijk AA, Broering DC, et al. Pathophysiology and clinical significance of the abdominal compartment syndrome [Ｊ]. Zentralbl Chir, 2001； 126(8): 605-609.
- 2. Hong JJ, Cohn SM, Perez JM, et al. Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Br J Surg, 2002； 89(5): 591-596.
- 3. Moore AF, Hargest R, Martin M, et al. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Br J Surg, 2004； 91(9): 1102-1110.
- 4. Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement： validity and methodology [Ｊ]. J Trauma, 2001； 50(2): 297-302.
- 5. 萬勇, 葛穎, 王大慶, 等. 膀胱壓、胃內(nèi)壓與腹內(nèi)壓的相關(guān)性研究 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2003； 10(4): 383-384.
- 6. 黎介壽. 急性腹腔間室綜合征及其護(hù)理 [Ｊ]. 中華護(hù)理雜志, 2007； 42(3): 209-211.
- 7. Sabiston Ed. Textbook of surgery [M]. 17th eds. Philadelphia: Saunders. 2004: 628-630.
- 8. Saggi BH, Sugerman HJ, Ivatury RR, et al. Abdominal co-mpartment syndrome [Ｊ]. J Trauma, 1998； 45(3): 597-609.
- 9. 吳在德. 肝疾病 [A]. 見: 吳在德主編. 外科學(xué) [M]. 第5版. 北京: 人民衛(wèi)生出版社, 2000: 582-585.
- 10. Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance [Ｊ]. Arch Surg, 1995； 130(5): 544-547.
- 11. Sieh KM, Chu KM, Wong J. Intra-abdominal hypertension and abdominal compartment syndrome [Ｊ]. Langenbecks Arch Surg, 2001； 386(1): 53-61.
- 12. 王大慶, 葛穎, 龔宗煉, 等. 不同水平腹內(nèi)壓對(duì)豬血流動(dòng)力學(xué)和氧代謝指標(biāo)的影響 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008； 15(5): 333-336.
- 13. Joynt GM, Ramsay SJ, Buckley TA. Intra-abdominal hypertension-implications for the intensive care physician [Ｊ]. Ann Acad Med Singapore, 2001； 30(3): 310-319.
- 14. Schachtrupp A, Graf J, Tons C, et al. Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension [Ｊ]. J Trauma, 2003； 55(4): 734-740.
- 15. Blevins DV, Khanduja KS. Abdominal compartment syndr-ome with massive lower-extremity edema caused by colonic obstruction and distention [Ｊ]. Am Surg, 2001； 67(5): 451-453.
- 16. Yokoyama Y, Alterman DM, Sarmadi AH, et al. Hepatic vascular response to elevated intraperitoneal pressure in the rat [Ｊ]. J Surg Res, 2002； 105(2): 86-94.
- 17. Nakatani T, Sakamoto Y, Kaneko I, et al. Effects of intra-abdominal hypertension on hepatic energy metabolism in a rabbit model [Ｊ]. J Trauma, 1998； 44(3): 446-453.
- 18. Loi P, De Backer D, Vincent JL. Abdominal compartment syndrome [Ｊ]. Acta Chir Belg, 2001； 101(2): 59-64.
- 19. Doty JM, Saggi BH, Blocher CR, et al. Effects of increased renal parenchymal pressure on renal function [Ｊ]. J Trauma, 2000； 48(5): 874-877.
- 20. Doty JM, Saggi BH, Sugerman HJ, et al. Effect of increased renal venous pressure on renal function [Ｊ]. J Trauma, 1999； 47(6): 1000-1003.
- 21. Sugrue M, Jones F, Deane SA, et al. Intra-abdominal hypertension is an independent cause of postoperative renal impairment [Ｊ]. Arch Surg， 1999； 134(10): 1082-1085.
- 22. Hunter JD, Damani Z. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Anaesthesia, 2004； 59(9): 899-907.
- 23. Biancofiore G, Bindi L, Romanlli AM, et al. Renal failure and abdominal hypertension after liver transplantation: determination of critical intra-abdominal pressure [Ｊ]. Liver Transpl, 2002； 8(12): 1175-1181.
- 24. Biancofiore G, Bindi ML, Romanelli AM, et al. Postoperative intra-abdominal pressure and renal function after liver transplantation [Ｊ]. Arch Surg， 2003； 138(7): 703-706.
- 25. 楊新平, 姜洪池. 腹腔內(nèi)高壓與腹腔間室綜合征 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2002； 9(6): 451-453.
- 26. Offner PJ, de Souza AL, Moore EE, et al. Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma [Ｊ]. Arch Surg, 2001； 136(6): 676-681.