Kim In Byung, Prowle John, Baldwin Ian, Bellomo Rinaldo
Austin Health, Austin Hospital, Melbourne, Victoria, Australia.
Anaesth Intensive Care. 2012 Jan;40(1):79-89. doi: 10.1177/0310057X1204000107.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are significantly associated with morbidity and mortality. We performed a prospective observational study and applied recently published consensus criteria to measure and describe the incidence of IAH and ACS, identify risk factors for their development and define their association with outcomes. We studied 100 consecutive patients admitted to our general intensive care unit. We recorded relevant demographic, clinical data and maximal (max) and mean intra-abdominal pressure (IAP). We measured and defined IAH and ACS using consensus guidelines. Of our study patients, 42% (by IAPmax) and 38% (by IAPmean) had IAH. Patients with IAH had greater mean body mass index (30.4 ± 9.6 vs 25.4 ± 5.6 kg/m(2), P=0.005), Acute Physiology and Chronic Health Evaluation III score (78.2 ± 28.5 vs 65.5 ± 29.2, P=0.03) and central venous pressure (12.8 ± 4.8 vs 9.2 ± 3.5 mmHg, P <0.001), lower abdominal perfusion pressure (67.6±13.5 vs 79.3 ± 17.3 mmHg, P <0.001) and lower filtration gradient (51.2 ± 14.8 vs 71.6 ± 17.7 mmHg; P <0.001). Risk factors associated with IAH were body mass index =30 (P <0.001), higher central venous pressure (P <0.001), presence of abdominal infection (P=0.005) and presence of sepsis on admission (P=0.035). Abdominal compartment syndrome developed in 4% of patients. IAP was not associated with an increased risk of mortality after adjusting for other confounders. We conclude that, in a general population of critically ill patients, using consensus guidelines, IAH was common and significantly associated with obesity and sepsis on admission. In a minority of patients, IAH was associated with abdominal compartment syndrome. In this cohort IAH was not associated with an increased risk of mortality.
腹腔内高压（IAH）和腹腔间隔室综合征（ACS）与发病率和死亡率显著相关。我们进行了一项前瞻性观察性研究，并应用最近发表的共识标准来测量和描述IAH和ACS的发生率，确定其发生的危险因素，并明确它们与预后的关联。我们研究了连续入住我院综合重症监护病房的100例患者。我们记录了相关的人口统计学、临床数据以及最大（max）和平均腹腔内压力（IAP）。我们使用共识指南测量并定义了IAH和ACS。在我们的研究患者中，42%（根据IAPmax）和38%（根据IAPmean）患有IAH。患有IAH的患者平均体重指数更高（30.4±9.6 vs 25.4±5.6 kg/m²，P = 0.005）、急性生理与慢性健康状况评价III评分更高（78.2±28.5 vs 65.5±29.2，P = 0.03）以及中心静脉压更高（12.8±4.8 vs 9.2±3.5 mmHg，P < 0.001），而腹部灌注压更低（67.6±13.5 vs 79.3±17.3 mmHg，P < 0.001）且滤过梯度更低（51.2±14.8 vs 71.6±17.7 mmHg；P < 0.001）。与IAH相关的危险因素包括体重指数≥30（P < 0.001）、更高的中心静脉压（P < 0.001）、存在腹部感染（P = 0.005）以及入院时存在脓毒症（P = 0.035）。4%的患者发生了腹腔间隔室综合征。在对其他混杂因素进行校正后，IAP与死亡率增加无关。我们得出结论，在重症患者的总体人群中，使用共识指南时，IAH很常见，且与入院时的肥胖和脓毒症显著相关。在少数患者中，IAH与腹腔间隔室综合征相关。在这个队列中，IAH与死亡率增加无关。
