De Waele J J, De laet I, Malbrain M L N G
Intensive Care Unit, Ghent University Hospital, Gent, Belgium.
Acta Clin Belg. 2007;62 Suppl 1:16-25.
Intraabdominal hypertension (IAH) is increasingly appreciated by intensivists as an important cause of organ dysfunction, even at pressure levels which were previously thought to be harmless. Therefore, the goal of this review is to describe the different methods commonly used in clinical practice for intraabdominal pressure (IAP) measurement, the advised methodology for each measurement method, and finally to give a rational approach for IAP monitoring in daily clinical practice.
A Medline search of the English literature was performed using the term "intra abdominal pressure" and "measurement". This resulted in 194 studies, which were then analysed based on the title and abstract. Only clinical studies in human subjects with IAP measurement or related issues as the subject of the study, were considered for inclusion in the study. Reviews, animal experiments and case reports were excluded, while one specific review on IAP measurement and 3 large animal studies (domestic swine > 40 kg) were included in the analysis. This left us with 19 studies, published between 1984 and 2006: 1 specific review, 2 studies in children, 13 in adults and 3 in domestic swine. The references from these studies were searched for relevant articles that may have been missed in the primary search. These articles served as the basis for the recommendations below.
Clinical data regarding the validation of new IAP measurement methods or the reliability of established measurement techniques are scarce. The transvesical route, which has been studied most extensively, can be used as reliable route for intermittent IAP measurement, as long as instillation volumes below 25mL are used. Continuous IAP and APP monitoring can be done via a balloon-tipped catheter placed in the stomach or directly intraperitoneal.
Rational IAP monitoring should be based on a site specific protocol, based on known risk factors, the monitoring equipment available and nursing staff experience, and should be linked directly to a local treatment protocol.
腹内高压（IAH）日益受到重症监护医师的重视，被视为器官功能障碍的一个重要原因，即使在以前认为无害的压力水平下也是如此。因此，本综述的目的是描述临床实践中常用的不同腹内压（IAP）测量方法、每种测量方法的推荐方法，最后给出日常临床实践中IAP监测的合理方法。
使用“腹内压”和“测量”这两个术语对英文文献进行了Medline检索。这检索出194项研究，然后根据标题和摘要进行分析。仅将以IAP测量或相关问题为研究主题的人体临床研究纳入本研究。综述、动物实验和病例报告被排除，而一项关于IAP测量的特定综述和3项大型动物研究（体重>40kg的家猪）被纳入分析。这使我们得到了1984年至2006年间发表的19项研究：1项特定综述、2项儿童研究、13项成人研究和3项家猪研究。对这些研究的参考文献进行检索，以查找在初步检索中可能遗漏的相关文章。这些文章作为以下建议的基础。
关于新IAP测量方法的验证或既定测量技术的可靠性的临床数据很少。研究最广泛的经膀胱途径可作为间歇性IAP测量的可靠途径，只要注入量低于25mL即可。连续IAP和APP监测可通过放置在胃内或直接腹腔内的带气囊导管进行。
合理的IAP监测应基于特定部位的方案，该方案基于已知的危险因素、可用的监测设备和护理人员的经验，并应直接与当地的治疗方案相联系。
