Cheatham M L, Malbrain M L N G
Department of Surgical Education, Orlando Regional Medical Center, 86 West Underwood Street, Mailpoint #100, Orlando, Florida 32806 USA.
Acta Clin Belg. 2007;62 Suppl 1:98-112.
Cardiovascular dysfunction and failure are commonly encountered in the patient with intraabdominal hypertension or abdominal compartment syndrome. Accurate assessment and optimization of preload, contractility, and afterload, in conjunction with appropriate goal-directed resuscitation and abdominal decompression when indicated, are essential to restoring end-organ perfusion and maximizing patient survival. The validity of traditional hemodynamic resuscitation endpoints, such as pulmonary artery occlusion pressure and central venous pressure, must be reconsidered in the patient with intra-abdominal hypertension as these pressure-based estimates of intravascular volume have significant limitations in patients with elevated intra-abdominal pressure. If such limitations are not recognized, misinterpretation of the patient's cardiac status is likely, resulting in inappropriate and potentially detrimental therapy. Appropriate fluid administration is mandatory as under-resuscitation leads to organ failure and over-resuscitation the development of secondary abdominal compartment syndrome, both of which are associated with increased morbidity and mortality. Volumetric monitoring techniques have been proven to be superior to traditional intra-cardiac filling pressures in directing the appropriate resuscitation of this patient population. Calculation of the "abdominal perfusion pressure", defined as mean arterial pressure minus intra-abdominal pressure, has been shown to be a beneficial resuscitation endpoint as it assesses not only the severity of the patient's intra-abdominal hypertension, but also the adequacy of abdominal blood flow. Application of a goal-directed resuscitation strategy, including abdominal decompression when indicated, improves cardiac function, reverses end-organ failure, and minimizes intra-abdominal hypertension-related patient morbidity and mortality.
心血管功能障碍和衰竭在腹腔高压或腹腔间隔室综合征患者中很常见。准确评估和优化前负荷、心肌收缩力和后负荷，结合适当的目标导向复苏以及在必要时进行腹腔减压，对于恢复终末器官灌注和最大化患者生存率至关重要。在腹腔高压患者中，必须重新审视传统血流动力学复苏终点（如肺动脉闭塞压和中心静脉压）的有效性，因为这些基于压力的血管内容量估计在腹腔内压力升高的患者中有显著局限性。如果不认识到这些局限性，很可能会对患者的心脏状况产生误解，导致不适当且可能有害的治疗。适当的液体输注是必不可少的，因为复苏不足会导致器官衰竭，而复苏过度会导致继发性腹腔间隔室综合征的发生，这两者都与发病率和死亡率增加有关。在指导对这类患者进行适当复苏方面，容积监测技术已被证明优于传统的心内充盈压。“腹腔灌注压”的计算（定义为平均动脉压减去腹腔内压力）已被证明是一个有益的复苏终点，因为它不仅评估患者腹腔高压的严重程度，还评估腹腔血流的充足性。应用目标导向的复苏策略，包括在必要时进行腹腔减压，可改善心脏功能，逆转终末器官衰竭，并将与腹腔高压相关的患者发病率和死亡率降至最低。
