Department of Laparoscopy, Jesús Usón Minimally Invasive Surgery Center (JUMISC), Cáceres, Spain.
J Surg Res. 2013 Oct;184(2):1028-34. doi: 10.1016/j.jss.2013.04.041. Epub 2013 May 10.
The gastrointestinal system is the most sensitive to the presence of intra-abdominal hypertension. We aimed to assess the early prognostic value of gastric air tonometry as a predictor of inadequate splanchnic perfusion and determine its relation with abdominal perfusion pressure (APP).
Twenty-five Large White swine were used for this study. A control group and two study groups were included, in which intra-abdominal pressure (IAP) was elevated with Co2 to 20 and 30 mmHg during 5 h. We measured the intramucosal gastric pH (pHim) and determined gastric luminal PCO2 (PgCO2) and PgCO2gap (gastric luminal CO2-arterial CO2) to evaluate gastric acidity. APP was indirectly obtained through IAP and mean arterial pressure. Additionally, histopathologic samples of small intestine were obtained and analyzed.
pHim showed a decrease in IAP groups, with statistical significance in the 30 mmHg group, 90 min after stabilization period (P < 0.01). Serum lactate showed delayed alteration when compared with pHim, with significant increase, 180 min after stabilization (P < 0.05). The values of PgCO2 and PCO2gap were increased in IAP groups, being statistically significant in the 30 mmHg group, 120 and 150 min, respectively, after stabilization. In increased IAP groups, there was a time progressive decrease of APP, with statistically significant differences observed between groups at 20 min (P < 0.001). The histopathology study revealed parenchymal injury of the intestine at 30 mmHg.
Tonometry is sensitive to the increase in IAP and relates to the reduction of APP generated by splanchnic hypoperfusion.
胃肠道系统对腹腔内高压的存在最为敏感。我们旨在评估胃张力测定作为预测内脏灌注不足的早期预后价值，并确定其与腹内压（APP）的关系。
本研究使用了 25 头大白猪。包括对照组和两组研究组，其中在 5 小时内通过 CO2 将腹内压（IAP）升高至 20mmHg 和 30mmHg。我们测量了黏膜内胃 pH（pHim），并测定了胃腔 PCO2（PgCO2）和 PgCO2 间隙（胃腔 CO2-动脉 CO2），以评估胃酸度。APP 通过 IAP 和平均动脉压间接获得。此外，还获得了小肠的组织病理学样本并进行了分析。
IAP 组的 pHim 下降，稳定期后 90 分钟时 30mmHg 组有统计学意义（P < 0.01）。与 pHim 相比，血清乳酸的变化延迟，稳定期后 180 分钟时显著增加（P < 0.05）。IAP 组的 PgCO2 和 PCO2 间隙值增加，稳定期后 120 分钟和 150 分钟时，30mmHg 组有统计学意义。在 IAP 升高的组中，APP 呈时间性下降，组间差异在 20 分钟时具有统计学意义（P < 0.001）。组织病理学研究显示 30mmHg 时肠实质损伤。
张力测定对 IAP 的增加敏感，并与内脏灌注不足引起的 APP 减少有关。
