Carry P Y, Banssillon V
Service d'Anesthésie-Réanimation, CH Lyon-Sud, Pierre-Bénite.
Ann Fr Anesth Reanim. 1994;13(3):381-99. doi: 10.1016/S0750-7658(94)80046-4.
The abdominal pressure is a hydrostatic one, which can be measured in the bladder, the rectum and the stomach. In physiologic conditions, the abdominal pressure is variable, with peaks as high as 100 to 200 mmHg at the time of defecation, cough. The increase in abdominal pressure elicited by abdominal distension or compression acts directly on the abdominal compartment, indirectly on the thoracic compartment, and modifies the circulation and the ventilation. Venous return is decreased as the inferior vena cava is compressed. The systemic resistances are also increased as the abdominal vessels are compressed. Therefore the circulation is mainly distributed to the superior part of the body. Although the cardiac output is decreased, the usual haemodynamic parameters remain in the normal range: arterial pressure is increased, heart rate is unchanged, central venous pressure is increased, cardiac failure is unusual. The abdominal distension is also responsible for a restrictive respiratory syndrome, mainly due to the ascension of the diaphragm. The compression of the abdominal content explains renal effects and the decreased diuresis. A sustained increase in abdominal pressure occurs in several clinical conditions. During coelioscopy, abdominal pressure is a under control and the cardiovascular effects are minor. Insufflation with CO2 carries the risk of hypercapnia, gas embolism and pneumothorax. During abdominal tamponade, anuria is directly related to the level of pressures. At an abdominal pressure over 25 mmHg, anuria is common and decompression becomes essential. The G suit increases arterial pressure either by elevating vascular resistances or increasing blood content in the upper part of the body. Therefore cardiac tolerance can be decreased especially in cardiac patients. The adverse effects of abdominal pressure can also be observed in case of peritoneal dialysis and ascites. The risk of regurgitation associated with an increased abdominal pressure must also be kept in mind. The abdominal pressure plays an important role in anaesthesia as well as in surgery. Therefore its measurement, which is easy, should become a routine.
腹内压是一种静水压力，可在膀胱、直肠和胃中进行测量。在生理状态下，腹内压是可变的，排便、咳嗽时峰值可达100至200 mmHg。腹部膨胀或受压引起的腹内压升高直接作用于腹腔，间接作用于胸腔，并改变循环和通气。下腔静脉受压导致静脉回流减少。腹部血管受压时全身阻力也会增加。因此循环主要分布到身体上部。虽然心输出量减少，但通常的血流动力学参数仍在正常范围内：动脉压升高，心率不变，中心静脉压升高，心力衰竭不常见。腹部膨胀还会导致限制性呼吸综合征，主要是由于膈肌上抬。腹部内容物受压解释了对肾脏的影响和尿量减少。在几种临床情况下会出现腹内压持续升高。在腹腔镜检查期间，腹内压可控，心血管影响较小。二氧化碳气腹有发生高碳酸血症、气体栓塞和气胸的风险。在腹部压迫期间，无尿与压力水平直接相关。腹内压超过25 mmHg时，无尿很常见，减压变得至关重要。抗荷服通过提高血管阻力或增加身体上部的血容量来升高动脉压。因此，尤其是心脏病患者，心脏耐受性可能会降低。在腹膜透析和腹水情况下也可观察到腹内压的不良影响。还必须牢记与腹内压升高相关的反流风险。腹内压在麻醉和手术中都起着重要作用。因此，其测量简便，应成为常规操作。
