Pierri A, Munegato G, Carraro L, Zaccaria F, Tiso E, Zotti E F
Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Padova, Italy.
J Am Coll Surg. 1995 Oct;181(4):299-302.
The operative treatment of a large abdominal incisional hernia increases intra-abdominal pressure (IAP). This study was done to verify if this IAP elevation acts on the cardiocirculatory function.
Hemodynamic measurements were performed in five patients who underwent massive incisional hernioplasty before and after abdominal wall closure.
Reduction of a large abdominal hernia increases (+226 percent) IAP, which can produce serious hemodynamic alterations, manifested in two patients by a fall of cardiac output (-30 percent), without significant variations of heart rate and arterial pressure. Cardiac output is decreased secondary to decreased venous return, despite the increase in measured central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP).
During massive incisional hernioplasty, CVP cannot be used as an indicator of venous return to the heart as it reflects a composite of venous filling pressure, pleural pressure, and transmitted IAP. Transmural CVP and PCWP, and not directly measured CVP and PCWP, should be used as clinical indicators of venous return to the heart in this situation.
大型腹部切口疝的手术治疗会增加腹内压（IAP）。本研究旨在验证这种IAP升高是否对心脏循环功能产生影响。
对5例行大型切口疝修补术的患者在腹壁关闭前后进行血流动力学测量。
大型腹部疝的修复使IAP升高（+226%），这可导致严重的血流动力学改变，2例患者表现为心输出量下降（-30%），心率和动脉压无显著变化。尽管测得的中心静脉压（CVP）和肺毛细血管楔压（PCWP）升高，但心输出量因静脉回流减少而降低。
在大型切口疝修补术中，CVP不能用作心脏静脉回流的指标，因为它反映的是静脉充盈压、胸膜压力和传递的IAP的综合情况。在这种情况下，应使用跨壁CVP和PCWP，而非直接测量的CVP和PCWP，作为心脏静脉回流的临床指标。
