Dr D. Joshi Institute of Liver Studies, King's College Hospital, London, UK.
Liver Int. 2011 Sep;31(8):1171-8. doi: 10.1111/j.1478-3231.2011.02557.x. Epub 2011 Jun 17.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome commonly occur in patients with liver disease.
We compared haemodynamic variables pre- and post-abdominal decompression in patients with acute Budd-Chiari syndrome (BCS) and patients with chronic liver disease (CLD), ascites and IAH.
Patients with IAH admitted to the Liver ICU, King's College Hospital were studied. Transpulmonary thermodilution cardiac output (CO) monitoring was performed with the PiCCO(®) system.
Ten patients with decompensated BCS (median age 39 years, 20-52) and eight patients with CLD (59 years, 33-65) and tense ascites requiring paracentesis were studied. Intra-abdominal pressure (IAP) was raised in both groups pre-intervention (BSC 23 mmHg, 17-40; CLD 26, 20-40). Intrathoracic blood volume (ITBVI) was persistently low in the BCS group (632 ml/m(2) , 453-924) despite volume resuscitation. Post-intervention, reduction in IAP was noted in both groups (BCS P<0.001, CLD P<0.0001). The ITBVI increased (P=0.001) in the BCS group only. An increase in cardiac index (CI) and stroke volume index (SVI) was noted in both groups (BCS: CI P=0.003, SVI: P=0.007; CLD: CI P=0.005, SVI P=0.02). The central venous pressure did not change in either group and did not correlate with markers of flow (CI, SVI) or IAP. Both groups demonstrated an inverse relationship between IAP, CI and SVI.
Patients with BCS and IAH have evidence of central hypovolaemia. In addition to raised IAP, hepatic venous obstruction and caudate lobe hypertrophy limit venous return in patients with BCS. Reduction in IAP and re-establishment of caval flow restores preload with improvement in CO.
腹腔内高压（IAH）和腹腔间隔室综合征在肝病患者中很常见。
我们比较了急性布加综合征（BCS）和慢性肝病（CLD）、腹水和 IAH 患者腹部减压前后的血流动力学变量。
研究了 King's College Hospital 肝脏 ICU 收治的 IAH 患者。使用 PiCCO（®）系统进行经肺温度稀释心输出量（CO）监测。
研究了 10 例失代偿性 BCS 患者（中位年龄 39 岁，20-52 岁）和 8 例 CLD 患者（59 岁，33-65 岁）和需要行大量腹腔穿刺术的紧张性腹水患者。两组患者干预前 IAP 升高（BCS 23mmHg，17-40；CLD 26mmHg，20-40）。尽管进行了容量复苏，但 BCS 组的胸腔内血容量（ITBVI）持续较低（632ml/m2，453-924）。干预后，两组 IAP 均降低（BCS P<0.001，CLD P<0.0001）。仅 BCS 组的 ITBVI 增加（P=0.001）。两组的 CI 和 SVI 均增加（BCS：CI P=0.003，SVI P=0.007；CLD：CI P=0.005，SVI P=0.02）。两组中心静脉压均无变化，与流量标志物（CI、SVI）或 IAP 无相关性。两组 IAP、CI 和 SVI 呈负相关。
BCS 和 IAH 患者存在中心低血容量的证据。除了 IAP 升高外，肝静脉阻塞和尾状叶肥大限制了 BCS 患者的静脉回流。降低 IAP 和重新建立腔静脉血流恢复前负荷，心输出量改善。
