• 解放軍第180醫(yī)院普外科(福建泉州 362000);

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，15＜腹內(nèi)壓≤25 cm H2O為Ⅱ級，25＜腹內(nèi)壓≤35 cm H2O為Ⅲ級，35 cm H2O以上為Ⅳ級。 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18例、Ⅱ級13例、Ⅲ級11例、Ⅳ級3例。腹內(nèi)高壓組中所有級別者的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)計學(xué)意義(P＜0.05，P＜0.01)； 心率只在Ⅱ、Ⅲ、Ⅳ級的腹內(nèi)高壓組有顯著升高，呼吸頻率和PaCO2只在Ⅲ、Ⅳ級的腹內(nèi)高壓組有顯著升高，差異有統(tǒng)計學(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，對術(shù)后實施適時適度的醫(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

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國普外基礎(chǔ)與臨床雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

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)壓對豬血流動力學(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. 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. 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. 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. 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. 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. 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. 7. Sabiston Ed. Textbook of surgery [M]. 17th eds. Philadelphia: Saunders. 2004: 628-630.
  8. 8. Saggi BH, Sugerman HJ, Ivatury RR, et al. Abdominal co-mpartment syndrome [Ｊ]. J Trauma, 1998； 45(3): 597-609.
  9. 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. 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. 11. Sieh KM, Chu KM, Wong J. Intra-abdominal hypertension and abdominal compartment syndrome [Ｊ]. Langenbecks Arch Surg, 2001； 386(1): 53-61.
  12. 12. 王大慶, 葛穎, 龔宗煉, 等. 不同水平腹內(nèi)壓對豬血流動力學(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. 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. 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. 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. 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. 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. 18. Loi P, De Backer D, Vincent JL. Abdominal compartment syndrome [Ｊ]. Acta Chir Belg, 2001； 101(2): 59-64.
  19. 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. 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. 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. 22. Hunter JD, Damani Z. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Anaesthesia, 2004； 59(9): 899-907.
  23. 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. 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. 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. 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.