Akhobadze G R, Chkhaidze M G, Kanjaradze D V, Tsirkvadze I B, Ukleba V A
Neonatal and Pediatric Critical Care Department, G.Zhvania Pediatric Clinic, Tbilisi, Georgia.
Georgian Med News. 2011 Mar(192):58-64.
The abdominal compartment syndrome (ACS) is a result of increased intra-abdominal pressure (IAP) due to tissue edema or free fluid collecting in the abdominal cavity. Elevated pressure in the abdomen is referred to as intra-abdominal hypertension (IAH). The end result of ACS, if undetected and untreated, is multisystem organ failure and patient death. Intra-abdominal pressure monitoring should be strongly considered in all patients with this clinical presentation. Normal intra-abdominal pressure is 0-5 mm Hg. Physiologic compromise begins when the pressure rises above 8-10 mm Hg. Once the pressures increase beyond 20 mm Hg irreversible tissue injury occurs, ultimately resulting in ACS and multiple organ failure. Early recognition of rising abdominal pressure is critically important, because it allows prompt intervention which will prevent ACS from developing, leading to a much better prognosis for the patient. The purpose of the research was to: 1) Detect abdominal compartment syndrome in newborns with clinically suspicious intra-abdominal hypertension; 2) Identify intra-abdominal pressure numbers presented with clinical manifestation; 3) Measure and detect intra-abdominal pressure numbers presented with abdominal compartment syndrome; 4) Find correlation between intra-abdominal hypertension grade and patient outcome. For completion of our goal we selected and reviewed medical records of 155 neonatal patients from 2008 to 2010, who stayed in surgical neonatal intensive care unit for more than 7 days. We monitored IAP in patients with suspected ACS and different clinical presentation. According to our research we may come to the following conclusion: Intra-abdominal hypertension was confirmed in most suspected cases. Intra-abdominal pressure of >10 mmHg in patients with clinical suspicion may be considered as intra-abdominal hypertension. Intra-abdominal hypertension is in close correlation with presence of fluid in abdominal cavity proved by ultrasound investigation. Intra-abdominal pressure of ≥20 mmHg can be considered as a point of development of abdominal compartment syndrome. The grade of hypertension is in close correlation with patient outcome.
腹腔间隔室综合征（ACS）是由于组织水肿或腹腔内游离液体聚集导致腹腔内压力（IAP）升高的结果。腹腔内压力升高被称为腹腔内高压（IAH）。如果未被发现和治疗，ACS的最终结果是多系统器官衰竭和患者死亡。对于所有有此临床表现的患者，应强烈考虑进行腹腔内压力监测。正常腹腔内压力为0 - 5 mmHg。当压力升至8 - 10 mmHg以上时，生理功能开始受到损害。一旦压力超过20 mmHg，就会发生不可逆的组织损伤，最终导致ACS和多器官衰竭。早期识别腹腔压力升高至关重要，因为这能促使及时干预，从而防止ACS的发生，为患者带来更好的预后。该研究的目的是：1）在临床上怀疑有腹腔内高压的新生儿中检测腹腔间隔室综合征；2）确定出现临床表现时的腹腔内压力数值；3）测量和检测出现腹腔间隔室综合征时的腹腔内压力数值；4）找出腹腔内高压分级与患者预后之间的相关性。为实现我们的目标，我们选择并回顾了2008年至2010年期间在外科新生儿重症监护病房住院超过7天的155例新生儿患者的病历。我们对疑似ACS和不同临床表现的患者进行了IAP监测。根据我们的研究，我们可以得出以下结论：大多数疑似病例中证实存在腹腔内高压。临床怀疑患者腹腔内压力>10 mmHg可被视为腹腔内高压。超声检查证实腹腔内高压与腹腔内有液体密切相关。腹腔内压力≥20 mmHg可被视为腹腔间隔室综合征发展的一个节点。高血压分级与患者预后密切相关。
