Tyagi A, Singh S, Kumar M, Sethi A K
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India.
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India.
Int J Obstet Anesth. 2017 Nov;32:33-40. doi: 10.1016/j.ijoa.2017.05.005. Epub 2017 May 10.
Critically ill obstetric patients may have risk factors for intra-abdominal hypertension. This study evaluated the intra-abdominal pressure and its effect on organ function and the epidemiology of intra-abdominal hypertension.
Obstetric patients admitted to an Intensive Care Unit, with an anticipated stay greater than 24hours, were included. Intra-abdominal pressure was measured daily via a Foley catheter, based on intravesical pressure.
One-hundred-and-one patients were enrolled. The intra-abdominal pressure was 5-7mmHg in 34%; 7-12mmHg in 60%; and ≥12mmHg (intra-abdominal hypertension) in 6%. All six patients with intra-abdominal hypertension were pregnant at the time of admission. The intra-abdominal pressure in four patients normalized to <12mmHg following delivery, but in the remaining two it persisted ≥12mmHg and both these patients died. Correlation between intra-abdominal pressure and organ dysfunction was weak (r=0.211). Statistical comparison between patients with and without intra-abdominal hypertension for risk factors, daily intra-abdominal pressures, and Sequential Organ Failure Assessment score could not be done due to the disproportionately small number of patients with intra-abdominal hypertension as opposed to those without (6 versus 95). Intra-abdominal pressure did not significantly differ between survivors and non-survivors (8.5±1.1 vs 7.9±1.7mmHg, P=0.079).
The incidence of intra-abdominal hypertension in critically ill obstetric patients was lower than previously defined for mixed Intensive Care Unit populations, with an association with the pregnant state. Normalization of intra-abdominal pressure after delivery was associated with better survival. There was no correlation between intra-abdominal pressure and organ function or mortality.
危重症产科患者可能存在腹内高压的危险因素。本研究评估了腹内压及其对器官功能的影响以及腹内高压的流行病学情况。
纳入入住重症监护病房、预计住院时间超过24小时的产科患者。基于膀胱内压，通过Foley导尿管每日测量腹内压。
共纳入101例患者。腹内压为5 - 7mmHg的患者占34%；7 - 12mmHg的患者占60%；≥12mmHg（腹内高压）的患者占6%。所有6例腹内高压患者入院时均为妊娠状态。4例患者产后腹内压恢复正常至<12mmHg，但其余2例患者腹内压持续≥12mmHg，且这2例患者均死亡。腹内压与器官功能障碍之间的相关性较弱（r = 0.211）。由于腹内高压患者数量与无腹内高压患者数量相比过少（6例对95例），无法对腹内高压患者和无腹内高压患者在危险因素、每日腹内压及序贯器官衰竭评估评分方面进行统计学比较。幸存者与非幸存者的腹内压无显著差异（8.5±1.1 vs 7.9±1.7mmHg，P = 0.079）。
危重症产科患者腹内高压的发生率低于先前针对综合重症监护病房人群所定义的发生率，且与妊娠状态有关。产后腹内压恢复正常与更好的生存率相关。腹内压与器官功能或死亡率之间无相关性。
