Malbrain M L N G, Chiumello D, Cesana B M, Reintam Blaser A, Starkopf J, Sugrue M, Pelosi P, Severgnini P, Hernandez G, Brienza N, Kirkpatrick A W, Schachtrupp A, Kempchen J, Estenssoro E, Vidal M G, De Laet I, De Keulenaer B L
Intensive Care Unit, ZiekenhuisNetwerk Antwerpen, ZNA Stuivenberg, Antwerpen, Belgium -
Minerva Anestesiol. 2014 Mar;80(3):293-306. Epub 2013 Dec 12.
Intra-abdominal hypertension (IAH), defined as a pathologically increase in intraabdominal pressure, is commonly found in critically ill patients. While IAH has been associated with several abdominal as well as extra-abdominal conditions, few studies have examined the occurrence of IAH in relation to mortality. The aim of this paper was to evaluate the prognostic role of IAH and its risk factors at admission in critically ill patients across a wide range of settings and countries. An individual patient meta-analysis of all available data and a systematic review of published (in full or as abstract) medical databases and studies between 1996 and June 2012 were performed. The search was limited to "clinical trials" and "randomized controlled trials", "adults", using the terms "intra-abdominal pressure", "intraabdominal hypertension" combined with any of the terms "outcome" and "mortality". All together data on 2707 patients, representing 21 centers from 11 countries was obtained. Data on 1038 patients were not analysed because of the following exclusion criteria: no IAP value on admission (N.=712), absence of information on ICU outcome (N.=195), age <18 or >95 years (N.=131). Data from 1669 individual patients (19 centers from 9 countries) were analyzed in the meta-analysis. Presence of IAH was defined as a sustained increase in IAP equal to or above 12 mmHg. At admission the mean overall IAP was 9.9±5.0 mmHg, with 463 patients (27.7%) presenting IAH with a mean IAP of 16.3±3.4 mmHg. The only independent predictors for IAH were SOFA score and fluid balance on the day of admission. Five hundred thirteen patients (30.8%) died in intensive care. The independent predictors for intensive care mortality were IAH, SAPS II score, SOFA score and admission category. This systematic review and individual patient data meta-analysis shows that IAH is frequently present in critically ill patients and it is an independent predictor for mortality.
腹内高压（IAH）定义为腹内压病理性升高，在重症患者中很常见。虽然IAH与多种腹部及腹部外疾病有关，但很少有研究探讨IAH的发生与死亡率的关系。本文旨在评估IAH在广泛的医疗环境和国家中对重症患者的预后作用及其入院时的危险因素。对所有可用数据进行了个体患者荟萃分析，并对1996年至2012年6月期间发表（全文或摘要）的医学数据库和研究进行了系统评价。搜索仅限于“临床试验”和“随机对照试验”、“成人”，使用“腹内压”、“腹内高压”与“结局”和“死亡率”中的任何一个术语组合。总共获得了来自11个国家21个中心的2707例患者的数据。由于以下排除标准，1038例患者的数据未进行分析：入院时无腹内压值（n = 712）、无重症监护结局信息（n = 195）、年龄<18岁或>95岁（n = 131）。荟萃分析中分析了来自9个国家19个中心的1669例个体患者的数据。IAH的存在定义为腹内压持续升高至12 mmHg或以上。入院时总体平均腹内压为9.9±5.0 mmHg，463例患者（27.7%）出现IAH，平均腹内压为16.3±3.4 mmHg。IAH的唯一独立预测因素是入院当天的序贯器官衰竭评估（SOFA）评分和液体平衡。513例患者（30.8%）在重症监护中死亡。重症监护死亡率的独立预测因素是IAH、简化急性生理学评分（SAPS）II、SOFA评分和入院类别。这项系统评价和个体患者数据荟萃分析表明，IAH在重症患者中经常出现，并且是死亡率的独立预测因素。
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