Biancofiore Gianni, Bindi Maria L, Romanelli Anna M, Bisà Massimo, Boldrini Antonella, Consani Giovanni, Filipponi Franco, Mosca Franco
Post-surgical and Transplant Intensive Care Unit, Azienda Ospedaliera Pisana, Pisa, Italy.
Arch Surg. 2003 Jul;138(7):703-6. doi: 10.1001/archsurg.138.7.703.
Intra-abdominal hypertension frequently threatens renal function early after orthotopic liver transplantation (OLT).
A prospective study of consecutive patients who underwent OLT.
The intensive care unit of a National Health Service teaching hospital.
The intra-abdominal pressure (IAP) of 108 consecutive patients who underwent OLT was postoperatively measured 3 times a day for 72 hours using the urinary bladder technique. Intra-abdominal hypertension was defined as an IAP of 25 mm Hg or higher.
Thirty-four patients (31%) had a high IAP. Acute renal failure developed in 17 recipients (16%), 11 (65%) of whom had intra-abdominal hypertension (P<.01), with a mean +/- SD IAP of 27.9 +/- 9.9 mm Hg vs 18.6 +/- 5.2 mm Hg in those without acute renal failure (P<.001). The subjects with a high IAP were more frequently administered loop diuretics to maintain adequate diuresis (P<.001) and had a low mean arterial pressure on the day of surgery (P<.01), despite the fact that they were given more intravenous fluids (P<.01) and did not differ in the need for inotropic drugs. Logistic regression analysis showed that intraoperative transfusions of more than 15 U, respiratory failure, and intra-abdominal hypertension (P<.01) were independent risk factors for renal failure. The length of intensive care unit stay was similar in the patients with a normal and a high IAP, but mortality was higher among the latter (P =.02).
Intra-abdominal hypertension is common after OLT and is significantly associated with renal failure, reduced urinary output, and intensive care unit mortality. It is, therefore, worth monitoring IAP in those undergoing OLT.
原位肝移植（OLT）术后早期，腹腔内高压常对肾功能构成早期威胁。
对连续接受OLT的患者进行前瞻性研究。
一家国民保健服务教学医院的重症监护病房。
采用膀胱测压技术，对108例连续接受OLT的患者术后72小时内每天测量3次腹腔内压力（IAP）。腹腔内高压定义为IAP≥25mmHg。
34例患者（31%）IAP升高。17例受者（16%）发生急性肾衰竭，其中11例（65%）存在腹腔内高压（P<0.01），急性肾衰竭患者的平均±标准差IAP为27.9±9.9mmHg，无急性肾衰竭患者为18.6±5.2mmHg（P<0.001）。IAP升高的患者更频繁地使用袢利尿剂以维持足够尿量（P<0.001），且手术当天平均动脉压较低（P<0.01），尽管他们接受了更多静脉补液（P<0.01），且在使用血管活性药物方面无差异。Logistic回归分析显示，术中输血超过15U、呼吸衰竭和腹腔内高压（P<0.01）是肾衰竭的独立危险因素。IAP正常和升高的患者在重症监护病房的住院时间相似，但后者死亡率更高（P = 0.02）。
OLT术后腹腔内高压常见，且与肾衰竭、尿量减少及重症监护病房死亡率显著相关。因此，对接受OLT的患者监测IAP是值得 的。
