Hunter J D, Damani Z
Department of Anaesthetics and Intensive Care, Macclesfield District General Hospital, Macclesfield, UK.
Anaesthesia. 2004 Sep;59(9):899-907. doi: 10.1111/j.1365-2044.2004.03712.x.
The pressure within the abdominal cavity is normally little more than atmospheric pressure. However, even small increases in intra-abdominal pressure can have adverse effects on renal function, cardiac output, hepatic blood flow, respiratory mechanics, splanchnic perfusion and intracranial pressure. Although intra-abdominal pressure can be measured directly, this is invasive and bedside measurement of intra-abdominal pressure is usually achieved via the urinary bladder. This cheap, easy approach has been shown to produce results that correlate closely with directly measured abdominal pressures. Significant increases in intra-abdominal pressure are seen in a wide variety of conditions commonly encountered in the intensive care unit, such as ruptured aortic aneurysm, abdominal trauma and acute pancreatitis. Abdominal compartment syndrome describes the combination of increased intra-abdominal pressure and end-organ dysfunction. This syndrome has a high mortality, most deaths resulting from sepsis and multi-organ failure. Detection of abdominal compartment syndrome requires close surveillance of intra-abdominal pressure in patients thought to be at risk of developing intra-abdominal hypertension. The only available treatment for established abdominal compartment syndrome is decompressive laparotomy. Prevention of abdominal compartment syndrome after laparotomy by adoption of an open abdomen approach may be preferable in the patient at significant risk of developing intra-abdominal hypertension, but this has not been demonstrated in any large trials. Most surgeons prefer to adopt a 'wait and see' policy, only intervening when clinical deterioration is associated with a significant increase in intra-abdominal pressure.
腹腔内压力通常仅略高于大气压。然而，即使腹腔内压力的小幅升高也可能对肾功能、心输出量、肝血流量、呼吸力学、内脏灌注和颅内压产生不利影响。虽然腹腔内压力可以直接测量，但这是一种侵入性操作，床边测量腹腔内压力通常通过膀胱来实现。这种廉价、简便的方法已被证明所产生的结果与直接测量的腹腔压力密切相关。在重症监护病房常见的多种情况下，如主动脉瘤破裂、腹部创伤和急性胰腺炎，都可见腹腔内压力显著升高。腹腔间隔室综合征描述了腹腔内压力升高与终末器官功能障碍的组合。该综合征死亡率很高，大多数死亡是由败血症和多器官功能衰竭导致的。对于被认为有发生腹腔内高压风险的患者，检测腹腔间隔室综合征需要密切监测腹腔内压力。对于已确诊的腹腔间隔室综合征，唯一可行的治疗方法是减压剖腹术。对于有显著发生腹腔内高压风险的患者，采用开放腹腔的方法预防剖腹术后的腹腔间隔室综合征可能更好，但这在任何大型试验中都未得到证实。大多数外科医生倾向于采取“观望”策略，仅在临床恶化与腹腔内压力显著升高相关时才进行干预。
