腹内高压的心脏手术患者肾功能的优化：专家意见
Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion.
作者信息
Moll Vanessa, Khanna Ashish K, Kurz Andrea, Huang Jiapeng, Smit Marije, Swaminathan Madhav, Minear Steven, Parr K Gage, Prabhakar Amit, Zhao Manxu, Malbrain Manu L N G
机构信息
Department of Anesthesiology, Division of Critical Care Medicine, University of Minnesota, Minneapolis, MN, USA.
Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, GA, USA.
出版信息
Perioper Med (Lond). 2024 Jul 12;13(1):72. doi: 10.1186/s13741-024-00416-5.
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) affects up to 42% of cardiac surgery patients. CSA-AKI is multifactorial, with low abdominal perfusion pressure often overlooked. Abdominal perfusion pressure is calculated as mean arterial pressure minus intra-abdominal pressure (IAP). IAH decreases cardiac output and compresses the renal vasculature and renal parenchyma. Recent studies have highlighted the frequent occurrence of IAH in cardiac surgery patients and have linked the role of low perfusion pressure to the occurrence of AKI. This review and expert opinion illustrate current evidence on the pathophysiology, diagnosis, and therapy of IAH and ACS in the context of AKI.
摘要
心脏手术相关急性肾损伤（CSA-AKI）影响多达42%的心脏手术患者。CSA-AKI是多因素的，低腹部灌注压常常被忽视。腹部灌注压计算为平均动脉压减去腹内压（IAP）。腹内高压（IAH）降低心输出量并压迫肾血管和肾实质。最近的研究强调了IAH在心脏手术患者中的频繁发生，并将低灌注压的作用与急性肾损伤的发生联系起来。本综述和专家意见阐述了在急性肾损伤背景下IAH和腹腔间隔室综合征（ACS）的病理生理学、诊断和治疗方面的现有证据。
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