Malbrain Manu L N G, Ameloot Koen, Gillebert Carl, Cheatham Michael L
Intensive Care Unit, Ziekenhuis Netwek Antwerpen, Campus Stuivenberg/St-Erasmus, Lange Beeldekensstraat 267, Antwerp 6, Belgium.
Am Surg. 2011 Jul;77 Suppl 1:S23-30.
Cardiopulmonary dysfunction and failure are commonly encountered in the patient with intra-abdominal hypertension (IAH) or abdominal compartment syndrome. Accurate assessment and optimization of preload, contractility, and afterload in conjunction with appropriate goal-directed resuscitation and assessment of fluid responsiveness are essential to restore end-organ perfusion. In patients with IAH, the traditional "barometric" preload indicators such as pulmonary artery occlusion pressure and central venous pressure are erroneously increased. Volumetric monitoring techniques have been proven to be superior in directing the appropriate resuscitation together with targeted abdominal perfusion pressure. If such limitations are not recognized, misinterpretation of the patient's cardiac status is likely, resulting in inappropriate and potentially detrimental therapy. IAH also markedly affects the mechanical properties of the chest wall and consequently also the respiratory function. Altered mechanical properties of the chest wall may limit ventilation, influence the work of breathing, affect the interaction between the respiratory muscles, hasten the development of respiratory failure, and interfere with gas exchange. Pulmonary monitoring is important to understand the relationships between intra-abdominal pressure and chest wall mechanics and the impact of IAH on ventilator-induced lung injury, lung distention, recruitment, and lung edema.
心肺功能障碍和衰竭在腹内高压（IAH）或腹腔间隔室综合征患者中很常见。准确评估并优化前负荷、收缩力和后负荷，结合适当的目标导向复苏和液体反应性评估，对于恢复终末器官灌注至关重要。在IAH患者中，传统的“气压式”前负荷指标，如肺动脉闭塞压和中心静脉压会出现错误升高。容积监测技术已被证明在指导适当复苏以及目标性腹腔灌注压方面更具优势。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，从而导致不适当且可能有害的治疗。IAH还会显著影响胸壁的力学特性，进而影响呼吸功能。胸壁力学特性的改变可能会限制通气、影响呼吸功、影响呼吸肌之间的相互作用、加速呼吸衰竭的发展并干扰气体交换。肺部监测对于理解腹内压与胸壁力学之间的关系以及IAH对呼吸机诱导的肺损伤、肺扩张、肺复张和肺水肿的影响非常重要。
