Prasad G Raghavendra, Subba Rao J V, Aziz Amtul, Rashmi T M
Department of Paediatric Surgery, Deccan College of Medical Sciences, Princess Esra Hospital, Hyderabad, Telangana, India.
Department of Anaesthesia, Deccan College of Medical Sciences, Princess Esra Hospital, Hyderabad, Telangana, India.
J Indian Assoc Pediatr Surg. 2017 Jul-Sep;22(3):134-138. doi: 10.4103/jiaps.JIAPS_222_15.
Abdomen, a closed compartment, is prone to raised intra-abdominal pressure (IAP) in the postoperative period. After a critical value of ≥ 15 cm of water, IAP produces abdominal compartment syndrome (ACS). ACS leads to reduced venous return, reduced cardiac output, and domino effect of organ dysfunction, leading to death. Hence, it is the need of hour to monitor IAP to pick up intra-abdominal hypertension (IAH) and ACS. This routine facilitates early institution of treatment measures.
To study IAP in abdominal operations in neonates, infants, and older children and to promote concept of routine measurement of IAP as standard care.
Intravesical route was used to measure IAP in this prospective observational study. Seventy-nine pediatric abdominal surgeries met with criteria of availability of complete data for analysis and formed the cohort of the study. All major, infective, traumatic, tumor-related abdominal surgeries were included in the study. Outcome, C-reactive protein (CRP), procalcitonin, platelet counts, Simplified Sequential Organ Failure Assessment Score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were the parameters analyzed. The World Society of ACS grading was adopted in the study with subdivision of normal into low-normal and high-normal subgroups.
Extended Mantel-Haenszel Chi-square statistical tool when applied for linear relationship showed a linear relationship with outcome ( < 0.05), CRP ( < 0.05), procalcitonin ( < 0.05), Simplified Sequential organ failure Assessment Score, and APACHE II. Platelet counts ( > 0.05) were not significantly correlated. Decision for laparotomy was delayed in cases of ACS.
Routine measure of IAP facilitates early recognition of IAH. This facilitates therapeutic measures to be initiated to reduce IAP. Early decision to decompress by laparotomy/laparostomy saves lives. Hence, routine IAP measurement should be a part of standard care in pediatric abdominal surgery.
腹部是一个封闭的腔室，术后易出现腹腔内压力（IAP）升高。当IAP达到≥15 cm水柱的临界值后，会产生腹腔间隔室综合征（ACS）。ACS会导致静脉回流减少、心输出量降低以及器官功能障碍的多米诺效应，最终导致死亡。因此，当下迫切需要监测IAP以发现腹腔内高压（IAH）和ACS。这一常规操作有助于早期采取治疗措施。
研究新生儿、婴儿及大龄儿童腹部手术中的IAP，并推广将IAP常规测量作为标准护理的理念。
在这项前瞻性观察研究中，采用膀胱内途径测量IAP。79例小儿腹部手术符合完整数据可供分析的标准，构成了研究队列。所有主要的、感染性的、创伤性的、肿瘤相关的腹部手术均纳入研究。分析的参数包括结局、C反应蛋白（CRP）、降钙素原、血小板计数、简化序贯器官衰竭评估评分以及急性生理与慢性健康状况评估II（APACHE II）评分。本研究采用世界腹腔间隔室综合征协会的分级标准，将正常分为低正常和高正常亚组。
应用扩展的Mantel-Haenszel卡方统计工具分析线性关系时，发现其与结局（<0.05）、CRP（<0.05）、降钙素原（<0.05）、简化序贯器官衰竭评估评分及APACHE II呈线性关系。血小板计数（>0.05）无显著相关性。ACS病例的剖腹手术决策延迟。
IAP的常规测量有助于早期识别IAH。这有利于启动治疗措施以降低IAP。通过剖腹手术/剖腹造口术进行早期减压的决策可挽救生命。因此，IAP常规测量应成为小儿腹部手术标准护理的一部分。
