Muturi A, Ndaguatha P, Ojuka Daniel, Kibet A
University of Nairobi, P. O Box 14523-00800, Nairobi, Kenya.
Department of Surgery, University of Nairobi, P. O Box 30197, Nairobi, 00100, Kenya.
BMC Emerg Med. 2017 Mar 23;17(1):10. doi: 10.1186/s12873-017-0120-y.
Intra-abdominal hypertension (IAH) affects almost every organ sytem.If it is not detected early and corrected, mortality would be high. The prevalence of IAH and abdominal compartment syndrome (ACS) at Kenyatta National Hospital (KNH) critical care units is not known. The aim of this sudy was to determine the prevalence and factors associated with development of IAH/ACS among critically ill surgical patients.
This was a cross sectional descriptive study involving surgical patients in critical care units at KNH, carried out from March 2015 to October 2015. One hundred and thirteen critically ill and ventilated patients 13 years or older were recruited into the study. Krohn's intravesical method was used to measure intra- abdominal pressure (IAP). Measurements were done at first contact, then at 12 and 24 h. Additional parameters recorded included: laboratory tests such as serum bilirubin and total blood count as well as clinical parameters such as urine output, vital signs and peak airway pressure, among others. Frequency, means and standard deviation were used to describe the data. Categorical variables e.g. age, were analysed using Chi square test and continous variables using student 't' test and Mann Whitney test as appropriate RESULT: A total of 113 consecutive surgical patients admitted to the critical care units were recruited. Of our study population, 71.7% (by IAP max) and 67.3% (by IAP mean) had IAH. Abdominal compartment syndrome (ACS) developed in 4.4% of the population. The following factors were significant determinants of risk of IAH : amount of IV fluids over 24 h (3949.6 vs 2931.1, p = 0.003, adjusted OR 1.0 [1.0-1.002]), haemoglobin values at admission (9.9 vs 12.0, p = <0.012, adjusted OR 0.6 [0.4-0.9]), peak airway pressure (28.4 vs 17.3; p = 0.018, adjusted OR 1.6 [1.1-2.4]) and synchronised intermittent mandatory ventilation (SIMV) (60 vs 32; p = 0.041, adjusted OR 1.4 [0.78-2.04]). Of those who had IAH; age, amount of iv fluids over 24 h, fluid balance and ventilator mode were significant determinants of risk of progression to ACS .
The prevalence of intraabdominal hypertension and abdominal compartment syndrome at KNH is high. Clinical parameters pertaining to fluids administration and ventilator mode are siginificant determinants.
腹腔内高压（IAH）几乎影响每个器官系统。若不及早发现并纠正，死亡率会很高。肯雅塔国家医院（KNH）重症监护病房中IAH和腹腔间隔室综合征（ACS）的患病率尚不清楚。本研究的目的是确定重症外科患者中IAH/ACS的患病率及其相关因素。
这是一项横断面描述性研究，于2015年3月至2015年10月在KNH的重症监护病房对手术患者进行。113名13岁及以上的重症且使用呼吸机的患者被纳入研究。采用克罗恩膀胱内测量法测量腹腔内压力（IAP）。在首次接触时进行测量，然后在12小时和24小时时再次测量。记录的其他参数包括：实验室检查，如血清胆红素和全血细胞计数，以及临床参数，如尿量、生命体征和气道峰压等。使用频率、均值和标准差来描述数据。分类变量，如年龄，采用卡方检验进行分析；连续变量则根据情况使用学生t检验和曼-惠特尼检验。结果：总共招募了113名连续入住重症监护病房的手术患者。在我们的研究人群中，71.7%（根据IAP最大值）和67.3%（根据IAP平均值）患有IAH。4.4%的人群发生了腹腔间隔室综合征（ACS）。以下因素是IAH风险的重要决定因素：24小时内静脉输液量（3949.6对2931.1，p = 0.003，调整后的OR为1.0 [1.0 - 1.002]）、入院时血红蛋白值（9.9对12.0，p = <0.012，调整后的OR为0.6 [0.4 - 0.9]）、气道峰压（28.4对17.3；p = 0.018，调整后的OR为1.6 [1.1 - 2.4]）和同步间歇指令通气（SIMV）（60对32；p = 0.041，调整后的OR为1.4 [0.78 - 2.04]）。在患有IAH的患者中，年龄、24小时内静脉输液量、液体平衡和呼吸机模式是进展为ACS风险的重要决定因素。
KNH中腹腔内高压和腹腔间隔室综合征的患病率很高。与液体输注和呼吸机模式相关的临床参数是重要决定因素。
