Seibel A, Sakka S G
Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, Diakonie Klinikum, Jung-Stilling-Krankenhaus, Siegen, Deutschland.
Anaesthesist. 2010 Dec;59(12):1091-8. doi: 10.1007/s00101-010-1754-2. Epub 2010 Aug 18.
Increased intraabdominal pressure (IAP) and abdominal compartment syndrome (ACS) are diseases which are often underestimated with respect to incidence and prognosis especially in critically ill patients. The clinical gold standard for the determination of IAP is the urinary bladder measurement technique. For assessment of hepatosplanchnic perfusion the indocyanine green plasma disappearance rate (ICG-PDR) has recently become a clinically attractive method. In this investigation a decrease in splanchnic perfusion caused by increased IAP was observed in critically ill patients with abdominal focused sepsis or postoperative systemic inflammatory response syndrome (SIRS). It was found that the reduction of ICG-PDR as a measure of splanchnic blood flow correlated with the increase of IAP, i.e. increased IAP is associated with lower ICG-PDR. Furthermore, the data suggest that a relevant decrease of splanchnic blood flow may appear even during lower IAP than previously assumed.
腹内压升高(IAP)和腹腔间隔室综合征(ACS)是发病率和预后常被低估的疾病,尤其是在危重症患者中。测定IAP的临床金标准是膀胱测量技术。对于肝内脏灌注的评估,吲哚菁绿血浆消失率(ICG-PDR)最近已成为一种具有临床吸引力的方法。在本研究中,在患有腹部聚焦性脓毒症或术后全身炎症反应综合征(SIRS)的危重症患者中观察到IAP升高导致的内脏灌注减少。研究发现,作为内脏血流指标的ICG-PDR降低与IAP升高相关,即IAP升高与较低的ICG-PDR相关。此外,数据表明,即使在比先前假设更低的IAP水平下,内脏血流也可能出现显著减少。