腹内压对接受腹疝修补术患者呼吸功能的影响。
Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair.
作者信息
Gaidukov Konstantin M, Raibuzhis Elena N, Hussain Ayyaz, Teterin Alexey Y, Smetkin Alexey A, Kuzkov Vsevolod V, Malbrain Manu Lng, Kirov Mikhail Y
机构信息
Konstantin M Gaidukov, Elena N Raibuzhis, Ayyaz Hussain, Alexey A Smetkin, Vsevolod V Kuzkov, Mikhail Y Kirov, Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, 163001 Arkhangelsk, Russia.
出版信息
World J Crit Care Med. 2013 May 4;2(2):9-16. doi: 10.5492/wjccm.v2.i2.9.
AIM
To determine the influence of intra-abdominal pressure (IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period.
METHODS
Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study. IAP monitoring was performed via both a balloon-tipped nasogastric probe [intragastric pressure (IGP), CiMON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure (IBP), UnoMeterAbdo-Pressure Kit, UnoMedical, Denmark] on five consecutive stages: (1) after tracheal intubation (AI); (2) after ventral hernia repair; (3) at the end of surgery; (4) during spontaneous breathing trial through the endotracheal tube; and (5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages.
RESULTS
The IAP (measured via both techniques) increased on average by 12% during surgery compared to AI (P < 0.02) and by 43% during spontaneous breathing through the endotracheal tube (P < 0.01). In parallel, the gradient between РаСО2 and EtCO2 [Р(а-et)CO2] rose significantly, reaching a maximum during the spontaneous breathing trial. The PаO2/FiO2 decreased by 30% one hour after tracheal extubation (P = 0.02). The dynamic compliance of respiratory system reduced intraoperatively by 15%-20% (P < 0.025). At all stages, we observed a significant correlation between IGP and IBP (r = 0.65-0.81, P < 0.01) with a mean bias varying from -0.19 mmHg (2SD 7.25 mmHg) to -1.06 mm Hg (2SD 8.04 mmHg) depending on the study stage. Taking all paired measurements together (n = 133), the median IGP was 8.0 (5.5-11.0) mmHg and the median IBP was 8.8 (5.8-13.1) mmHg. The overall r (2) value (n = 30) was 0.76 (P < 0.0001). Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mmHg (2SD 4.2 mmHg) with percentage error of 45.6%. Looking at changes in IAP between the different study stages, we found an excellent concordance coefficient of 94.9% comparing ΔIBP and ΔIGP (n = 117).
CONCLUSION
During ventral hernia repair, the IAP rise is accompanied by changes in Р(а-et)CO2 and PаO2/FiO2-ratio. Estimation of IAP via IGP or IBP demonstrated excellent concordance.
目的
确定腹内压（IAP）对腹疝手术修复后呼吸功能的影响，并比较围手术期两种不同的IAP测量方法。
方法
30例择期腹疝修复术后的成年患者纳入本前瞻性研究。通过球囊尖端鼻胃管[胃内压（IGP），CiMON，德国慕尼黑普ulsion医疗系统公司]和尿管[膀胱内压（IBP），丹麦UnoMedical公司的UnoMeterAbdo - Pressure套件]在五个连续阶段进行IAP监测：（1）气管插管后（AI）；（2）腹疝修复后；（3）手术结束时；（4）通过气管导管进行自主呼吸试验期间；（5）气管拔管后1小时。在所有研究阶段，患者均处于完全仰卧位。
结果
与AI相比，手术期间IAP（通过两种技术测量）平均升高12%（P < 0.02），通过气管导管进行自主呼吸期间升高43%（P < 0.01）。同时，PaCO2与EtCO2之间的梯度[P（a - et）CO2]显著升高，在自主呼吸试验期间达到最大值。气管拔管后1小时，PaO2/FiO2降低30%（P = 0.02）。术中呼吸系统的动态顺应性降低15% - 20%（P < 0.025）。在所有阶段，我们观察到IGP与IBP之间存在显著相关性（r = 0.65 - 0.81，P < 0.01），平均偏差根据研究阶段从-0.19 mmHg（2SD 7.25 mmHg）到-1.06 mmHg（2SD 8.04 mmHg）不等。将所有配对测量值（n = 133）汇总，IGP的中位数为8.0（5.5 - 11.0）mmHg，IBP的中位数为8.8（5.8 - 13.1）mmHg。总体r（2）值（n = 30）为0.76（P < 0.0001）。Bland和Altman分析显示，每位患者平均值的总体偏差为0.6 mmHg（2SD 4.2 mmHg），百分比误差为45.6%。观察不同研究阶段之间IAP的变化，比较ΔIBP和ΔIGP时，我们发现一致性系数极佳，为94.9%（n = 117）。
结论
在腹疝修复过程中，IAP升高伴随着P（a - et）CO2和PaO2/FiO2比值的变化。通过IGP或IBP评估IAP显示出极佳的一致性。
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