Intensive Care Unit, Hermanos Ameijeiras Hospital, San Lázaro and Belascoaín, La Habana, 10300, Cuba.
Ann Intensive Care. 2012 Jul 5;2 Suppl 1(Suppl 1):S13. doi: 10.1186/2110-5820-2-S1-S13.
Although the World Society for Abdominal Compartment Syndrome in its guidelines recommends midaxillary line (MAL) as zero reference level in intra-abdominal pressure (IAP) measurements in aiming at standardizing the technique, evidence supporting this suggestion is scarce. The aim of this study is to study if the zero reference position influences bladder pressure measurements as estimate for IAP.
The IAP of 100 surgical patients was measured during the first 24 h of admission to the surgical intensive care unit of General Calixto Garcia Hospital in Havana (Cuba) following laparotomy. The period was January 2009 to January 2010. The IAP was measured twice with a six-hour interval using the transurethral technique with a priming volume of 25 ml. IAP was first measured with the zero reference level placed at MAL (IAPMAL), followed by a second measurement at the level of the symphysis pubis (SP) after 3 minutes (IAPSP). Correlations were made between IAP and body mass index (BMI), type of surgery, gender, and age.
Mean IAPMAL was 8.5 ± 2.8 mmHg vs. IAPSP 6.5 ± 2.8 mmHg (p < 0.0001). The bias between measurements was 2.0 ± 1.5, 95% confidence interval of 1.4 to 3.0, upper limit of 4.9, lower limit of -0.9, and a percentage error of 35.1%. IAPMAL was consistently higher than IAPSP regardless of the type of surgery. The BMI correlated with IAP values regardless of the zero reference level (R2 = 0.4 and 0.3 with IAPMAL and IAPSP respectively, p < 0.0001).
The zero reference level has an important impact on IAP measurement in surgical patients after laparotomy and can potentially lead to over or underestimation. Further anthropometric studies are needed with regard to the relative MAL and SP zero reference position in relation to the theoretical ideal reference level at midpoint of the abdomen. Until better evidence is available, MAL remains the recommended zero reference position due to its best anatomical localization at iliac crest.
尽管世界腹横筋膜间隙综合征学会在其指南中建议将腋中线（MAL）作为腹腔内压（IAP）测量的零参考水平，旨在使技术标准化，但支持这一建议的证据很少。本研究旨在研究零参考位置是否会影响膀胱压力测量作为 IAP 的估计值。
2009 年 1 月至 2010 年 1 月，在古巴哈瓦那 General Calixto Garcia 医院外科重症监护病房对接受剖腹手术后的 100 例外科患者进行了 24 小时内的 IAP 测量。使用经尿道技术，预充 25ml 容量，两次测量 IAP，两次测量之间间隔 6 小时。首先将零参考水平置于 MAL（IAPMAL）测量 IAP，3 分钟后在耻骨联合水平（IAPSP）测量第二次。对 IAP 与体重指数（BMI）、手术类型、性别和年龄之间的关系进行了相关性分析。
IAPMAL 的平均值为 8.5 ± 2.8mmHg，IAPSP 为 6.5 ± 2.8mmHg（p < 0.0001）。两次测量之间的差值为 2.0 ± 1.5mmHg，95%置信区间为 1.4 至 3.0mmHg，上限为 4.9mmHg，下限为-0.9mmHg，误差百分比为 35.1%。无论手术类型如何，IAPMAL 始终高于 IAPSP。BMI 与 IAP 值相关，与零参考水平无关（与 IAPMAL 和 IAPSP 相关的 R2 分别为 0.4 和 0.3，p < 0.0001）。
剖腹手术后外科患者的零参考水平对 IAP 测量有重要影响，可能导致高估或低估。需要进一步进行人体测量学研究，以确定 MAL 和 SP 零参考位置与腹部中点的理论理想参考水平之间的相对关系。在获得更好的证据之前，由于 MAL 在髂嵴处的最佳解剖定位，MAL 仍然是推荐的零参考位置。
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