Deindl Philipp, Wagner Jula, Herden Uta, Schulz-Jürgensen Sebastian, Schild Raphael, Vettorazzi Eik, Bergers Marlies, Keck Maike, Singer Dominique, Fischer Lutz, Herrmann Jochen
Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
Department of Visceral Transplant Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
Pediatr Transplant. 2019 Nov;23(7):e13565. doi: 10.1111/petr.13565. Epub 2019 Aug 31.
IAH after LTX can impair perfusion and threaten graft viability. This study aimed to assess the feasibility of longitudinal IAP measurements as an IAH screening method in children after LTX. A cohort of 23 children with a mean age (range) 3.1 (3 months-14 years) who underwent LTX between May 2017 and February 2018 were evaluated retrospectively. Longitudinal IAP measurements were compared to bedside Doppler US monitoring data. In total, 425 IAP measurements and 257 US examinations were performed. The mean ± SD (range) time expenditure for IAP measurement was 1.9 ± 0.4 (0.5-3.2) minutes. The mean post-operative IAP was 7.9 ± 3.6 (1-25) mm Hg. IAH (IAP ≥ 10 mm Hg) was noted in 102 (24%) of 257 measurements. Agitation had a significant impact on IAP (estimate: 9.3 mm Hg, CI: 6.72-11.97, P < .01). In patients with TAC, IAP was increased (6.7 ± 2.1 vs 8.7 ± 3.1 mm Hg, P = .02) while peak portal venous velocities decreased (38 ± 27 vs 26 ± 22 cm/s, P = .03) after patch reduction. An abdominal compartment syndrome with severely impaired vascular flow was noted in one patient. Episodes of elevated IAP were noted in a large proportion of patients, underscoring the need for IAP monitoring in pediatric liver transplant recipients. The safety and low time expenditure associated with IAP measurement could be included easily into standard nursing procedures for these patients.
肝移植术后腹腔内高压（IAH）可损害灌注并威胁移植物存活。本研究旨在评估纵向测量腹内压（IAP）作为肝移植术后儿童IAH筛查方法的可行性。对2017年5月至2018年2月期间接受肝移植的23名平均年龄（范围）为3.1岁（3个月至14岁）的儿童队列进行回顾性评估。将纵向IAP测量结果与床边多普勒超声（US）监测数据进行比较。总共进行了425次IAP测量和257次US检查。IAP测量的平均±标准差（范围）时间为1.9±0.4（0.5 - 3.2）分钟。术后IAP的平均值为7.9±3.6（1 - 25）mmHg。在257次测量中有102次（24%）记录到IAH（IAP≥10 mmHg）。躁动对IAP有显著影响（估计值：9.3 mmHg，可信区间：6.72 - 11.97，P <.01）。在接受他克莫司（TAC）治疗的患者中，补片复位后IAP升高（6.7±2.1 vs 8.7±3.1 mmHg，P =.02），而门静脉峰值流速降低（38±27 vs 26±22 cm/s，P =.03）。一名患者出现了伴有严重血管血流受损的腹腔间隔室综合征。在很大一部分患者中记录到IAP升高事件，这突出了对小儿肝移植受者进行IAP监测的必要性。IAP测量的安全性和低时间消耗可以很容易地纳入这些患者的标准护理程序中。
