Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Discipline of Anaesthesiology, and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
PLoS One. 2023 Aug 28;18(8):e0290451. doi: 10.1371/journal.pone.0290451. eCollection 2023.
Intra-abdominal hypertension and abdominal compartment syndrome are common with clinically significant consequences. We investigated the pathophysiological effects of raised IAP as part of a more extensive exploratory animal study. The study design included both pneumoperitoneum and mechanical intestinal obstruction models.
Forty-nine female swine were divided into six groups: a control group (Cr; n = 5), three pneumoperitoneum groups with IAPs of 20mmHg (Pn20; n = 10), 30mmHg (Pn30; n = 10), 40mmHg (Pn40; n = 10), and two mechanical intestinal occlusion groups with IAPs of 20mmHg (MIO20; n = 9) and 30mmHg (MIO30; n = 5).
There were significant changes (p<0.05) noted in all organ systems, most notably systolic blood pressure (SBP) (p<0.001), cardiac index (CI) (p = 0.003), stroke volume index (SVI) (p<0.001), mean pulmonary airway pressure (MPP) (p<0.001), compliance (p<0.001), pO2 (p = 0.003), bicarbonate (p = 0.041), hemoglobin (p = 0.012), lipase (p = 0.041), total bilirubin (p = 0.041), gastric pH (p<0.001), calculated glomerular filtration rate (GFR) (p<0.001), and urine output (p<0.001). SVV increased progressively as the IAP increased with no obvious changes in intravascular volume status. There were no significant differences between the models regarding their impact on cardiovascular, respiratory, renal and gastrointestinal systems. However, significant differences were noted between the two models at 30mmHg, with MIO30 showing worse metabolic and hematological parameters, and Pn30 and Pn40 showing a more rapid rise in creatinine.
This study identified and quantified the impact of intra-abdominal hypertension at different pressures on several organ systems and highlighted the significance of even short-lived elevations. Two models of intra-abdominal pressure were used, with a mechanical obstruction model showing more rapid changes in metabolic and haematological changes. These may represent different underlying cellular and vascular pathophysiological processes, but this remains unclear.
腹腔内高压和腹腔间隔室综合征是常见的，具有显著的临床后果。我们研究了升高的 IAP 的病理生理效应，这是更广泛的动物探索性研究的一部分。该研究设计包括气腹和机械性肠梗阻模型。
49 头雌性猪分为六组：对照组（Cr；n = 5）、三个 IAP 分别为 20mmHg（Pn20；n = 10）、30mmHg（Pn30；n = 10）、40mmHg（Pn40；n = 10）的气腹组，和两个 IAP 分别为 20mmHg（MIO20；n = 9）和 30mmHg（MIO30；n = 5）的机械性肠梗阻组。
所有器官系统都有显著变化（p<0.05），最显著的是收缩压（SBP）（p<0.001）、心指数（CI）（p = 0.003）、每搏量指数（SVI）（p<0.001）、平均肺动脉压（MPP）（p<0.001）、顺应性（p<0.001）、pO2（p = 0.003）、碳酸氢盐（p = 0.041）、血红蛋白（p = 0.012）、脂肪酶（p = 0.041）、总胆红素（p = 0.041）、胃 pH 值（p<0.001）、计算肾小球滤过率（GFR）（p<0.001）和尿量（p<0.001）。随着 IAP 的升高，SVV 逐渐增加，而血管内容量状态没有明显变化。两种模型对心血管、呼吸、肾脏和胃肠道系统的影响没有显著差异。然而，在 30mmHg 时，两种模型之间存在显著差异，MIO30 显示出更差的代谢和血液学参数，而 Pn30 和 Pn40 则显示出肌酐更快的上升。
本研究确定并量化了不同压力下腹腔内高压对多个器官系统的影响，并强调了即使是短暂升高的重要性。使用了两种腹腔内压力模型，其中机械性梗阻模型显示出更快速的代谢和血液学变化。这些可能代表不同的潜在细胞和血管病理生理过程，但这仍不清楚。
