腹腔高压症及腹腔压力监测在危重病人中的应用[1]

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1、腹腔高压症及腹腔压力监测彭沪背景19世纪后期，Eddy1890年，Heinricius1951年，Baggot1984年，KronResultsfromtheInternationalConferenceofExpertsonIntra-AbdominalHypertension(IAH)andAbdominalCompartmentSyndrome(ACS)DEFINITIONSIntensiveCareMedicine2006;32:1722-1732www.wsacs.orgINTRODUCTIONTOTHEDEFINITIONSInt

2、ra-abdominalhypertension(IAH)andabdominalcompartmentsyndrome(ACS)havebeenincreasinglyrecognizedinthecriticallyillascausesofsignificantmorbidityandmortality.Thevarietyofpreviousdefinitionshasledtoconfusionanddifficultyincomparingonestudytoanother.Aninternationalgroupofcritic

3、alcarespecialistsconvenedtostandardizedefinitionsforbothIAHandACSaswellasestablishstandardsforthemeasurementofintra-abdominalpressure(IAP).www.wsacs.orgWHATISINTRA-ABDOMINALPRESSURE?ElevatedIAPisacommonfindingintheICUIAPincreasesanddecreaseswithrespirationIAPisdirectlyaffec

4、tedby:SolidorganorhollowvisceravolumeSpaceoccupyinglesionsAscites,blood,fluid,tumorsConditionsthatlimitexpansionoftheabdominalwallBurneschars,third-spaceedemawww.wsacs.orgWHATISABDOMINALPERFUSIONPRESSURE?“Abdominalperfusionpressure(APP)=meanarterialpressure(MAP)minusintra-a

5、bdominalpressure(IAP)=MAP-IAP.”ThecriticalIAPthatleadstoorganfailurevariesbypatientAsinglethresholdIAPcannotbegloballyappliedtoallpatientsAnalogoustocerebralperfusionpressure,APPassessesnotonlytheseverityofIAP,butalsotherelativeadequacyofabdominalbloodflowAPPissuperiortoIAP

6、,arterialpH,basedeficit,andarteriallactateinpredictingorganfailureandpatientoutcomeFailuretomaintainAPP>60mmHgbyday3predictssurvivalwww.wsacs.orgHOWSHOULDIAPBEMEASURED?“IAPshouldbeexpressedinmmHgandmeasuredatend-expirationinthecompletesupinepositionafterensuringthatabdomina

7、lmusclecontractionsareabsentandwiththetransducerzeroedatthelevelofthemidaxillaryline.”PhysicalexamisinaccurateinpredictingIAPSensitivity40-61%Positivepredictivevalue45-76%IAPmeasurementsareessentialtothediagnosisofelevatedIAPandthemanagementofIAHAvarietyoftechniquesmaybeuse

8、dtomeasureIAPwww.wsacs.orgWHATISTHEREFERENCESTANDARDFORIAP?“Thereferencestandardfo