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ID:25377988
大小:4.29 MB
页数:57页
时间:2018-11-19
《腹腔高压症及腹腔压力监测在危重病人中的应用》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
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.orgINTRODUCTIONTOTHEDEFINITIONSIntr
2、a-abdominalhypertension(IAH)andabdominalcompartmentsyndrome(ACS)havebeenincreasinglyrecognizedinthecriticallyillascausesofsignificantmorbidityandmortality.Thevarietyofpreviousdefinitionshasledtoconfusionanddifficultyincomparingonestudytoanother.Aninternationalgroupofcritical
3、carespecialistsconvenedtostandardizedefinitionsforbothIAHandACSaswellasestablishstandardsforthemeasurementofintra-abdominalpressure(IAP).www.wsacs.orgWHATISINTRA-ABDOMINALPRESSURE?ElevatedIAPisacommonfindingintheICUIAPincreasesanddecreaseswithrespirationIAPisdirectlyaffected
4、by:SolidorganorhollowvisceravolumeSpaceoccupyinglesionsAscites,blood,fluid,tumorsConditionsthatlimitexpansionoftheabdominalwallBurneschars,third-spaceedemawww.wsacs.orgWHATISABDOMINALPERFUSIONPRESSURE?“Abdominalperfusionpressure(APP)=meanarterialpressure(MAP)minusintra-abdom
5、inalpressure(IAP)=MAP-IAP.”ThecriticalIAPthatleadstoorganfailurevariesbypatientAsinglethresholdIAPcannotbegloballyappliedtoallpatientsAnalogoustocerebralperfusionpressure,APPassessesnotonlytheseverityofIAP,butalsotherelativeadequacyofabdominalbloodflowAPPissuperiortoIAP,arte
6、rialpH,basedeficit,andarteriallactateinpredictingorganfailureandpatientoutcomeFailuretomaintainAPP>60mmHgbyday3predictssurvivalwww.wsacs.orgHOWSHOULDIAPBEMEASURED?“IAPshouldbeexpressedinmmHgandmeasuredatend-expirationinthecompletesupinepositionafterensuringthatabdominalmuscl
7、econtractionsareabsentandwiththetransducerzeroedatthelevelofthemidaxillaryline.”PhysicalexamisinaccurateinpredictingIAPSensitivity40-61%Positivepredictivevalue45-76%IAPmeasurementsareessentialtothediagnosisofelevatedIAPandthemanagementofIAHAvarietyoftechniquesmaybeusedtomeas
8、ureIAPwww.wsacs.orgWHATISTHEREFERENCESTANDARDFORIAP?“Thereferencestandardfo
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