Department of Intensive Care Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, 11426, Saudi Arabia.
Ann Intensive Care. 2012 Jul 5;2 Suppl 1(Suppl 1):S4. doi: 10.1186/2110-5820-2-S1-S4.
The importance of intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) in cirrhotic patients with septic shock is not well studied. We evaluated the relationship between IAP and APP and outcomes of cirrhotic septic patients, and assessed the ability of these measures compared to other common resuscitative endpoints to differentiate survivors from nonsurvivors.
This study was a post hoc analysis of a randomized double-blind placebo-controlled trial in which mean arterial pressure (MAP), central venous oxygen saturation (ScvO2) and IAP were measured every 6 h in 61 cirrhotic septic patients admitted to the intensive care unit. APP was calculated as MAP - IAP. Intra-abdominal hypertension (IAH) was defined as mean IAP ≥ 12 mmHg, and abdominal hypoperfusion as mean APP < 60 mmHg. Measured outcomes included ICU and hospital mortality, need for renal replacement therapy (RRT) and ventilator- and vasopressor-free days.
IAH prevalence on the first ICU day was 82%, and incidence in the first 7 days was 97%. Compared to patients with normal IAP, IAH patients had significantly higher ICU mortality (74.0% vs. 27.3%, p = 0.005), required more RRT (78.0% vs. 45.5%, p = 0.06) and had lower ventilator- and vasopressor-free days. On a multivariate logistic regression analysis, IAH was an independent predictor of both ICU mortality (odds ratio (OR), 12.20; 95% confidence interval (CI), 1.92 to 77.31, p = 0.008) and need for RRT (OR, 6.78; 95% CI, 1.29 to 35.70, p = 0.02). Using receiver operating characteristic curves, IAP (area under the curve (AUC) = 0.74, p = 0.004), APP (AUC = 0.71, p = 0.01), Acute Physiology and Chronic Health Evaluation II score (AUC = 0.71, p = 0.02), but not MAP, differentiated survivors from nonsurvivors.
IAH is highly prevalent in cirrhotic patients with septic shock and is associated with increased ICU morbidity and mortality.
在合并感染性休克的肝硬化患者中，腹腔内压（IAP）和腹部灌注压（APP）的重要性尚未得到充分研究。我们评估了 IAP 和 APP 与肝硬化感染性休克患者预后的关系，并评估了这些指标与其他常见复苏终点相比，区分存活者与非存活者的能力。
这是一项随机、双盲、安慰剂对照临床试验的事后分析，该试验共纳入 61 例入住重症监护病房的肝硬化感染性休克患者，每 6 小时测量一次平均动脉压（MAP）、中心静脉血氧饱和度（ScvO2）和 IAP。APP 计算为 MAP-IAP。腹腔内高压（IAH）定义为平均 IAP≥12mmHg，腹部低灌注定义为平均 APP＜60mmHg。测量的结果包括 ICU 死亡率、住院死亡率、需要肾脏替代治疗（RRT）和呼吸机及血管加压素无使用天数。
第 1 天 ICU 时 IAH 的患病率为 82%，第 1 个 7 天的发病率为 97%。与正常 IAP 的患者相比，IAH 患者的 ICU 死亡率显著更高（74.0% vs. 27.3%，p=0.005），需要更多的 RRT（78.0% vs. 45.5%，p=0.06），呼吸机及血管加压素无使用天数更少。在多变量逻辑回归分析中，IAH 是 ICU 死亡率（优势比（OR），12.20；95%置信区间（CI），1.92 至 77.31，p=0.008）和需要 RRT（OR，6.78；95%CI，1.29 至 35.70，p=0.02）的独立预测因素。使用受试者工作特征曲线，IAP（曲线下面积（AUC）=0.74，p=0.004）、APP（AUC=0.71，p=0.01）、急性生理学和慢性健康评估 II 评分（AUC=0.71，p=0.02），但 MAP 不能区分存活者与非存活者。
IAH 在合并感染性休克的肝硬化患者中非常普遍，与 ICU 发病率和死亡率增加相关。
