Liver Transplant Surgical Service and Liver Intensive Care Unit, Kings College London, Institute of Liver Studies, King's College Hospital, Denmark Hill, SE5 9RS, London, UK.
Ann Intensive Care. 2012 Jul 5;2 Suppl 1(Suppl 1):S12. doi: 10.1186/2110-5820-2-S1-S12.
Current assumptions rely on intra-abdominal pressure (IAP) being uniform across the abdominal cavity. The abdominal contents are, however, a heterogeneous mix of solid, liquid and gas, and pressure transmission may not be uniform. The current study examines the upper and lower IAP following liver transplantation.
IAP was measured directly via intra-peritoneal catheters placed at the liver and outside the bladder. Compartmental pressure data were recorded at 10-min intervals for up to 72 h following surgery, and the effect of intermittent posture change on compartmental pressures was also studied. Pelvic intra-peritoneal pressure was compared to intra-bladder pressure measured via a FoleyManometer.
A significant variation in upper and lower IAP of 18% was observed with a range of differences of 0 to 16 mmHg. A sustained difference in inter-compartmental pressure of 4 mmHg or more was present for 23% of the study time. Head-up positioning at 30° provided a protective effect on upper intra-abdominal pressure, resulting in a significant reduction in all patients. There was excellent agreement between intra-bladder and pelvic pressure.
A clinically significant variation in inter-compartmental pressure exists following liver transplantation, which can be manipulated by changes to body position. The existence of regional pressure differences suggests that IAP monitoring at the bladder alone may under-diagnose intra-abdominal hypertension and abdominal compartment syndrome in these patients. The upper and lower abdomen may need to be considered as separate entities in certain conditions.
目前的假设依赖于腹腔内的腹内压（IAP）是均匀的。然而，腹部内容物是固体、液体和气体的不均匀混合物，压力传递可能不均匀。本研究检查了肝移植后上腹部和下腹部的 IAP。
通过放置在肝脏和膀胱外的腹膜内导管直接测量 IAP。在手术后的 72 小时内，每隔 10 分钟记录一次隔室压力数据，并研究间歇性体位变化对隔室压力的影响。将盆腔腹膜内压与 FoleyManometer 测量的膀胱内压进行比较。
观察到上腹部和下腹部 IAP 存在 18%的显著差异，差异范围为 0 至 16mmHg。23%的研究时间存在持续的 4mmHg 或更大的隔室间压力差异。30°头高位对上腹部 IAP 有保护作用，所有患者的压力均显著降低。膀胱内压和盆腔压之间具有良好的一致性。
肝移植后存在明显的隔室间压力差异，可以通过改变体位来操纵。区域压力差异的存在表明，在这些患者中，仅在膀胱处监测 IAP 可能会低估腹腔内高压和腹腔间隔室综合征。在某些情况下，上腹部和下腹部可能需要被视为独立的实体。
