Balogh Z, De Waele J J, Malbrain M L N G
Department of Trauma, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia.
Acta Clin Belg. 2007;62 Suppl 1:26-32.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) can develop within 12 hours of ICU admission in high-risk patients. Until recently the intermittent intra-abdominal pressure (IAP) measurement via the urinary catheter was the clinical standard. This is a relatively labour intensive technique and its intermittent nature could prevent timely recognition of significant changes in IAP. The historical continuous IAP (CIAP) measurements were poorly reproducible (gastric route) or invasive/impractical (direct measurement). The aim of this paper is to review the current evidence on CIAP monitoring.
A broad Medline search of the English literature was performed using the terms of "intra abdominal pressure" and "continuous". This result was analysed based on the title and abstract. Only original clinical studies with continuous IAP measurement were considered in this review. New techniques of CIAP monitoring evaluated in large animal models are discussed as potential future directions.
There is a growing evidence of measuring (monitoring) CIAP using several techniques (gastric, direct abdominal, inferior vena cava, and urinary bladder. The strongest evidence supports the direct abdominal, the gastric and the bladder route. From these three techniques the CIAP monitoring via the bladder has excellent agreement with the current standard of intermittent bladder pressure measurement. While the direct measurement could be very accurate it is an invasive method and feasible in patient who underwent laparotomy or laparoscopy.
Until a better technique is available the CIAP monitoring via the bladder or stomach should be considered as the standard for continuous monitoring of the IAP. It is a less labour intensive, safe, less invasive and reliable method.
高危患者入住重症监护病房（ICU）后12小时内可发生腹腔内高压（IAH）和腹腔间隔室综合征（ACS）。直到最近，通过导尿管间歇性测量腹腔内压力（IAP）仍是临床标准。这是一种相对耗费人力的技术，其间歇性特点可能会妨碍及时识别IAP的显著变化。以往的连续IAP（CIAP）测量方法重复性差（经胃途径）或具有侵入性/不实用（直接测量）。本文旨在综述目前关于CIAP监测的证据。
使用“腹腔内压力”和“连续”等术语对英文文献进行广泛的医学文献检索。根据标题和摘要对结果进行分析。本综述仅考虑进行连续IAP测量的原始临床研究。在大型动物模型中评估的CIAP监测新技术作为潜在的未来方向进行了讨论。
越来越多的证据表明，可以使用多种技术（经胃、直接腹腔、下腔静脉和膀胱）测量（监测）CIAP。最有力的证据支持直接腹腔、经胃和膀胱途径。从这三种技术来看，通过膀胱进行的CIAP监测与目前间歇性膀胱压力测量的标准具有很好的一致性。虽然直接测量可能非常准确，但它是一种侵入性方法，仅适用于接受剖腹手术或腹腔镜检查的患者。
在有更好的技术可用之前，通过膀胱或胃进行CIAP监测应被视为IAP连续监测的标准。它是一种耗费人力较少、安全、侵入性较小且可靠的方法。
