Ruiz Ferrón F, Tejero Pedregosa A, Ruiz García M, Ferrezuelo Mata A, Pérez Valenzuela J, Quirós Barrera R, Rucabado Aguilar L
Servicio de Cuidados Críticos y Urgencias, Unidad de Medicina Intensiva, Hospital Médico-Quirúrgico, Complejo Hospitalario de Jaén, Jaén, España.
Med Intensiva. 2011 Jun-Jul;35(5):274-9. doi: 10.1016/j.medin.2011.02.009. Epub 2011 Apr 15.
To study the correlation between intraabdominal and intrathoracic pressure in patients with suspected intraabdominal hypertension.
A prospective, observational cohort study.
Polyvalent intensive care unit of a University hospital.
Twenty-seven medical-surgical patient dependent upon controlled mechanical ventilation due to acute respiratory failure and with several risk factors for intraabdominal hypertension (IAH).
Intraabdominal (IAP), esophageal (Peso) and airways pressure were measured under static (st) and dynamic (dyn) conditions. Respiratory system (Crs), lung (Cl) and chest wall compliance (Ccw)were calculated.
In 10 patients IAP > 12 mmHg (IAH, IAPst, 14 ± 2 [12-21] mmHg), while in the rest the pressure proved normal (n = 17; IAPst, 8 ± 2 [3-11] mmHg). Peso st was 11 ± 5 (2-27) and Peso dyn 7 ± 4 (2-24) cmH₂O. Depending on the presence or absence of IAH, Peso st was 9 ± 4 vs 7 ± 3 cmH₂O (p = 0.2) and Peso dyn 6 ± 2 vs 4 ± 3 cmH₂O (p = 0.3), respectively. The correlation between Peso st and dyn with IAPst was 0.5 (p= 0.003) and 0.4 (p = 0.03), respectively. The compliance components were decreased (Crs, 31 ± 8; Cl, 52 ± 22 and Ccw, 105 ± 50 ml/cmH₂O); Ccw was significantly lower in patients with IAH (81 ± 31 vs 118 ± 55 ml/cmH₂O; p = 0.02). The correlation coefficient between IAPst and Ccw was -0.7 (p < 0.001), and -0.5 (p = 0.002) with respect to Crs.
A stiffer chest wall was observed in patients with IAH. In patients with risk factors for IAH, pressures in these compartments were highly variable.
研究疑似腹腔内高压患者的腹腔内压力与胸腔内压力之间的相关性。
一项前瞻性观察性队列研究。
一家大学医院的多科室重症监护病房。
27例因急性呼吸衰竭依赖控制性机械通气且有多种腹腔内高压（IAH）危险因素的内科及外科患者。
在静态（st）和动态（dyn）条件下测量腹腔内压力（IAP）、食管压力（Peso）和气道压力。计算呼吸系统顺应性（Crs）、肺顺应性（Cl）和胸壁顺应性（Ccw）。
10例患者IAP>12 mmHg（IAH，IAPst，14±2 [12 - 21] mmHg），其余患者压力正常（n = 17；IAPst，8±2 [3 - 11] mmHg）。Peso st为11±5（2 - 27）cmH₂O，Peso dyn为7±4（2 - 24）cmH₂O。根据是否存在IAH，Peso st分别为9±4与7±3 cmH₂O（p = 0.2），Peso dyn分别为6±2与4±3 cmH₂O（p = 0.3）。Peso st和dyn与IAPst之间的相关性分别为0.5（p = 0.003）和0.4（p = 0.03）。顺应性成分降低（Crs，31±8；Cl，52±22；Ccw，105±50 ml/cmH₂O）；IAH患者的Ccw显著降低（81±31与118±55 ml/cmH₂O；p = 0.02）。IAPst与Ccw之间的相关系数为 - 0.7（p < 0.001），与Crs之间为 - 0.5（p = 0.002）。
IAH患者观察到胸壁更僵硬。在有IAH危险因素的患者中，这些腔室的压力变化很大。
