直接测压法测量腹内压正常值范围及腹水与腹内压波动关系的研究

Explore the normal range of intra-abdominal pressure with direct measurement and the relationship between ascites quantitation and intra-abdominal pressure

目的通过直接测压法寻找腹内压的正常范围,并探讨腹水量与腹内压的关系。方法采用前瞻性研究的方法,通过直接测压法测量腹内压,获得无腹水患者腹内压正常值范围。同时测定腹水组患者腹内压值,与无腹水组进行比较。取无腹水患者,在腹腔注入不同体积含化疗药物的生理盐水,动态监测腹水增加后腹内压的变化,并建立两者关系式。结果①67例无腹水患者直接测压法测得腹内压的95%的可信区间(95%CI)为4.99~6.11 mm Hg(1 mm Hg=0.133 kPa);②无腹水组的腹内压明显低于腹水组(t=-2.188,P=0.031);③无腹水患者腹内灌注生理盐水体积与腹内压变化之间具有显著的相关性(R=0.113,t=5.206,P<0.01)。设定灌注药体积为自变量(X),腹内压为因变量(Y),一元回归方程式为:Y=7.651X+1.491(P<0.01);④腹腔灌注生理盐水后获得腹内压测量值范围4~19 mm Hg。其中<12 mm Hg 48人次,12~15 mm Hg 52人次,16~20 mm Hg 5人次,21~25 mm Hg 0人次,>25 mm Hg 0人次,所有患者均未出现ACS。结论直接测压法腹内压的正常值范围是4.99~6.11 mm Hg,与Kron测量法正常值范围在数值上不同,需进一步研究确定两者之间的关系。腹水增多与腹内压的升高,存在正向线性关系,因此腹水增多时需警惕腹腔内高压(IAH)及腹腔间隔室综合征(ACS)的发生;腹水增多引起ACS可能与高压状态持续时间相关,早期缓解腹内高压,对预防和治疗ACS具有重要意义。

Objective To explore the normal range of intra-abdominal pressure(IAP) using direct measurement, and discuss the relationship between ascites quantitation and intra-abdominal pressure. Methods A prospective cohort study was conducted. We acquire the normal range of IAP in patients without ascites using direct measurement. Meanwhile, we compared the IAP of ascites group with non-ascites group. Then, we injected different volume of normal saline containing chemotherapeutics drugs into the abdominal cavity of non-ascites, monitor the change of IAP, and found the relationship between them.Results ① The 95% confidence interval of the IAP measuring by direct measurement in non-ascites was 4.99-6.11 mm Hg(1 mm Hg=0.133 kPa).②The IAP of non-ascites was significant lower than ascites group(t=-2.188, P=0.031).③A significant linear correlation was observed between the volume of normal saline and IAP(R=0.113, t=5.206, P<0.01), the regression equation was Y=7.651 X+1.491(P<0.01).④The range of IAP after injecting normal saline was 4-19 mm Hg. Among them, there were 52 between 12 and 15 mm Hg and 5 between 16 and 20 mm Hg. There were no patients between 21 and 25 mm Hg and >25 mm Hg. All the patients had no organ dysfunction or organ failure. Conclusion The normal range of IAP measuring by direct measurement is 4.99-6.11 mm Hg, which different from Kron technique in numerical, more studies are needed to explore the relation between them. An increase in ascites can lead the increase in IAP, and there is a linear correlation between them, so we should worry about intra abdominal hypertension(IAH) or abdominal compartment syndrome(ACS) when increase in ascites. The happen of ACS has relationship with the duration of high pressure caused by ascites, so reduce IAP timely has important significance in precention an treatment ACS.