Kılıç Bahriye, Yapıcı Nihan, Yapıcı Fikri, Kavaklı Ali Sait, Kudsioğlu Türkan, Kılıç Abdullah, Aykaç Zuhal
Department of Anesthesiology and Reanimation, Medicine Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2020 Jan 23;28(1):134-142. doi: 10.5606/tgkdc.dergisi.2020.18662. eCollection 2020 Jan.
The aim of this study was to investigate the intra-abdominal pressure changes and risk factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery.
Between July 2016 and January 2017, a total of 100 patients (74 males, 26 females; mean age 55.9±14.3 years; range, 19 to 75 years) who underwent cardiac surgery under cardiopulmonary bypass were included in the study. Patients" data including demographic and clinical characteristics and intra- and postoperative data were recorded. Intra-abdominal pressure was measured via a urinary catheter after anesthesia induction, on admission to the intensive care unit, and at postoperative 12 and 24 h. The patients were divided into two groups according to the intraabdominal pressure as Group 1 (≥12 mmHg; n=49) and Group 2 (<12 mmHg; n=51).
In the univariate regression analysis, high intra-abdominal pressure was related to intra-abdominal pressure measured after anesthesia induction (Odds Ratio =0.70, p=0.001), age (odds ratio=0.95, p=0.004), hypertension (odds ratio=4.51, p=0.0001), duration of cardiopulmonary bypass (odds ratio=0.97, p=0.0001), intraoperative lactate levels (odds ratio=0.53, p=0.0001), use of red blood cells (odds ratio=0.24, p=0.0001), use of dopamine (odds ratio=0.21, p=0.002), dobutamine (odds ratio=0.28, p=0.005), use of noradrenaline (odds ratio=0.25, p=0.016), postoperative lactate levels (odds ratio=0.60, p=0.0001), duration of cross-clamp (odds ratio=0.97, p=0.0001), atrial fibrillation (odds ratio=5.89, p=0.004), and acute kidney injury (odds ratio=8.33, p=0.048). In the multivariate analysis, the intra-abdominal pressure at baseline (odds ratio=0.70, p=0.045), age (odds ratio=0.93, p=0.032), hypertension (odds ratio=6.87, p=0.023), duration of cardiopulmonary bypass (odds ratio=0.98, p=0.062), intraoperative lactate levels (odds ratio=0.57, p=0.035), and use of red blood cells (odds ratio=0.19, p=0.003) remained statistically significant.
Our study results suggest that age, hypertension, duration of cardiopulmonary bypass, intraoperative lactate levels, and use of red blood cells are risk factors associated with elevated intra-abdominal pressure in patients undergoing cardiac surgery. Increased awareness of these risk factors and the addition of intra-abdominal pressure measurement to the standard follow-up scheme in patients with variable hemodynamics, low cardiac output, and high lactate levels in the intensive care unit may be useful in early diagnosis of complications and in decreasing morbidity.
本研究旨在调查心脏手术患者的腹腔内压力变化以及与腹腔内压力升高相关的危险因素。
2016年7月至2017年1月期间，共有100例在体外循环下接受心脏手术的患者（74例男性，26例女性；平均年龄55.9±14.3岁；范围19至75岁）纳入本研究。记录患者的人口统计学和临床特征以及术中和术后数据。在麻醉诱导后、入住重症监护病房时以及术后12小时和24小时通过导尿管测量腹腔内压力。根据腹腔内压力将患者分为两组，第1组（≥12 mmHg；n = 49）和第2组（<12 mmHg；n = 51）。
在单因素回归分析中，高腹腔内压力与麻醉诱导后测量的腹腔内压力（比值比=0.70，p = 0.001）、年龄（比值比=0.95，p = 0.004）、高血压（比值比=4.51，p = 0.0001）、体外循环持续时间（比值比=0.97，p = 0.0001）、术中乳酸水平（比值比=0.53，p = 0.0001）、红细胞使用情况（比值比=0.24，p = 0.0001）、多巴胺使用情况（比值比=0.21，p = 0.002）、多巴酚丁胺使用情况（比值比=0.28，p = 0.005）、去甲肾上腺素使用情况（比值比=0.25，p = 0.016）、术后乳酸水平（比值比=0.60，p = 0.0001）、阻断时间（比值比=0.97，p = 0.0001）、心房颤动（比值比=5.89，p = 0.004）和急性肾损伤（比值比=8.33，p = 0.048）有关。在多因素分析中，基线时的腹腔内压力（比值比=0.70，p = 0.045）、年龄（比值比=0.93，p = 0.032）、高血压（比值比=6.87，p = 0.023）、体外循环持续时间（比值比=0.98，p = 0.062）、术中乳酸水平（比值比=0.57，p = 0.035）和红细胞使用情况（比值比=0.19，p = 0.003）仍具有统计学意义。
我们的研究结果表明，年龄、高血压、体外循环持续时间、术中乳酸水平和红细胞使用情况是心脏手术患者腹腔内压力升高的相关危险因素。提高对这些危险因素的认识，并在重症监护病房中对血流动力学不稳定、心输出量低和乳酸水平高的患者在标准随访方案中增加腹腔内压力测量，可能有助于并发症的早期诊断并降低发病率。
