Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Örebro, Sweden.
Eur J Vasc Endovasc Surg. 2013 Jun;45(6):596-606. doi: 10.1016/j.ejvs.2013.03.002. Epub 2013 Mar 27.
This study aims to evaluate intra-peritoneal (ip) microdialysis after endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) in patients developing intra-abdominal hypertension (IAH), requiring abdominal decompression.
Prospective study.
A total of 16 patients with rAAA treated with an emergency EVAR were followed up hourly for intra-abdominal pressure (IAP), urine production and ip lactate, pyruvate, glycerol and glucose by microdialysis, analysed only at the end of the study. Abdominal decompression was performed on clinical criteria, and decompressed (D) and non-decompressed (ND) patients were compared.
The ip lactate/pyruvate (l/p) ratio was higher in the D group than in the ND group during the first five postoperative hours (mean 20 vs. 12), p = 0.005 and at 1 h prior to decompression compared to the fifth hour in the ND group (24 vs. 13), p = 0.016. Glycerol levels were higher in the D group during the first postoperative hours (mean 274.6 vs. 121.7 μM), p = 0.022. The IAP was higher only at 1 h prior to decompression in the D group compared to the ND group at the fifth hour (mean 19 vs. 14 mmHg).
Ip l/p ratio and glycerol levels are elevated immediately postoperatively in patients developing IAH leading to organ failure and subsequent abdominal decompression.
本研究旨在评估血管内主动脉修复（EVAR）破裂性腹主动脉瘤（rAAA）后发生腹腔内高压（IAH）并需要腹部减压的患者的腹腔内微透析。
前瞻性研究。
对 16 例接受紧急 EVAR 治疗的 rAAA 患者进行了随访，每小时记录一次腹腔内压（IAP）、尿量和腹腔内乳酸盐、丙酮酸、甘油和葡萄糖的微透析，仅在研究结束时进行分析。根据临床标准进行腹部减压，比较减压（D）和非减压（ND）患者。
在术后前 5 小时，D 组腹腔内乳酸盐/丙酮酸（l/p）比值高于 ND 组（平均 20 对 12），p = 0.005，与 ND 组第 5 小时相比，D 组在减压前 1 小时的比值更高（24 对 13），p = 0.016。D 组在术后第一小时甘油水平更高（平均 274.6 对 121.7 μM），p = 0.022。仅在 D 组，IAP 在减压前 1 小时高于 ND 组第 5 小时（平均 19 对 14 mmHg）。
在发生导致器官衰竭和随后进行腹部减压的 IAH 的患者中，腹腔内 l/p 比值和甘油水平在术后即刻升高。
