Pelosi P, Quintel M, Malbrain M L N G
Servizio di Anestesia e Rianimazione B, Department of Ambient, Health and Safety, Università degli Studi dell'lnsubria, Varese, Italy.
Acta Clin Belg. 2007;62 Suppl 1:78-88.
There has been an exponentially increasing interest in intra-abdominal hypertension (IAH). The intra-abdominal pressure (IAP) markedly affects the function of the respiratory system.
This review will focus on the available literature from the past few years. A Medline and Pubmed search was performed in order to find an answer to the question "What is the impact of increased IAP on respiratory function in the critically ill?".
In particular, increased IAP increases chest wall elastance (or decreases compliance) and promotes cranial shift of the diaphragm, with consequent reduction in lung volume and atelectasis formation. Compression of the lung parenchyma also triggers pulmonary infection. During general anaesthesia, in normal subjects, IAP does not affect the chest wall mechanics, but plays a relevant role in the caudal-cranial displacement of the abdominal content, the diaphragm and consequent changes in lung mechanics and function. In obese patients, the increased IAP is the major determinant of the reduction in lung volume, atelectasis formation and alterations in chest wall mechanics. In ARDS patients the measurement of IAP and chest wall mechanics is important for a better interpretation of respiratory mechanics, hemodynamics and appropriate setting of the ventilator. Furthermore, increased IAP promotes lung oedema, ventilator induced lung injury and reduced lymphatic flow in normal and diseased lungs.
Increased IAP markedly affects respiratory function in such a way that it has an impact on daily clinical practise.
人们对腹腔内高压（IAH）的兴趣呈指数级增长。腹腔内压力（IAP）对呼吸系统功能有显著影响。
本综述将聚焦过去几年的现有文献。进行了Medline和Pubmed检索，以回答“危重症患者IAP升高对呼吸功能有何影响？”这一问题。
具体而言，IAP升高会增加胸壁弹性（或降低顺应性），促使膈肌向头侧移位，进而导致肺容积减小和肺不张形成。肺实质受压还会引发肺部感染。在全身麻醉期间，对于正常受试者，IAP不影响胸壁力学，但在腹部内容物、膈肌的尾-头侧移位以及随之而来的肺力学和功能变化中起重要作用。在肥胖患者中，IAP升高是肺容积减小、肺不张形成和胸壁力学改变的主要决定因素。在急性呼吸窘迫综合征（ARDS）患者中，测量IAP和胸壁力学对于更好地解释呼吸力学、血流动力学以及正确设置呼吸机很重要。此外，IAP升高会促进正常和患病肺组织中的肺水肿、呼吸机诱导的肺损伤以及淋巴液流动减少。
IAP升高对呼吸功能有显著影响，从而对日常临床实践产生影响。
