Dalfino L, Malcangi V, Cinnella G, Brienza N
Emergency and Organ Transplantation Department, Anesthesia and Intensive Care Division, University of Bari, Bari, Italy.
Transplant Proc. 2006 Apr;38(3):838-40. doi: 10.1016/j.transproceed.2006.03.002.
Intra-abdominal hypertension (IAH) can affect liver hemodynamics but it is not known if has a significant clinical impact on liver function. The aim of this study was to investigate the relationship between IAH and liver function. A prospective study was performed in 110 adult intensive care unit (ICU) patients. Intra-abdominal pressure (IAP) was measured on admission and every other day, and liver sequential organ failure assessment (SOFA) score was collected whenever IAP was measured. IAH was defined by a IAP >or= 10 mm Hg, and liver dysfunction was defined by a hepatic SOFA score >or= 2. An overall IAH incidence of 56.3% was found (n = 62). Thirty-three patients presented a liver SOFA score >or= 2, with an overall incidence of 30%. Liver SOFA score of the group of patients with abdominal hypertension was higher than in group of patients without abdominal hypertension. (0.8 +/- 1.05 vs 0.4 +/- 0.7; P < .05), but IAH and liver dysfunction were not significantly associated (chi2 = 2.03; P = .15). When the whole sample was divided according to the worst IAP score (IAP < 10, IAP between 10 and 15, and IAP > 15), the corresponding liver dysfunction scores in the three groups were 0.35 +/- 0.6, 0.74 +/- 1, and 1.2 +/- 1.3, respectively (P = .01). A strict association between IAH and liver dysfunction was not found. Most likely, low levels of IAH, although able to reduce liver blood flow, are not per se sufficient to produce a real dysfunction; however, a correlation between the degree of IAH and the degree of hyperbilirubinemia exists. IAH does not seem to be an "on-off" phenomenon, but produces liver alterations for increasing levels of its severity.
腹内高压（IAH）可影响肝脏血流动力学，但尚不清楚其是否对肝功能有显著临床影响。本研究旨在探讨IAH与肝功能之间的关系。对110例成人重症监护病房（ICU）患者进行了一项前瞻性研究。入院时及每隔一天测量腹内压（IAP），每次测量IAP时收集肝脏序贯器官衰竭评估（SOFA）评分。IAH定义为IAP≥10 mmHg，肝功能障碍定义为肝脏SOFA评分≥2。IAH总发生率为56.3%（n = 62）。33例患者肝脏SOFA评分≥2，总发生率为30%。腹内高压组患者的肝脏SOFA评分高于无腹内高压组患者（0.8±1.05 vs 0.4±0.7；P <.05），但IAH与肝功能障碍无显著相关性（χ2 = 2.03；P =.15）。当根据最高IAP评分（IAP < 10、IAP在10至15之间以及IAP > 15）对整个样本进行划分时，三组相应的肝功能障碍评分分别为0.35±0.6、0.74±1和1.2±1.3（P =.01）。未发现IAH与肝功能障碍之间存在严格关联。很可能，低水平的IAH虽然能够减少肝脏血流，但本身不足以导致真正的功能障碍；然而，IAH程度与高胆红素血症程度之间存在相关性。IAH似乎不是一种“非此即彼”的现象，而是随着其严重程度的增加会导致肝脏改变。
