Elevated intra-abdominal pressure in acute decompensated heart failure
Elevated intra-abdominal pressure in acute decompensated heart failure
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DOI：
10.1016/j.jacc.2007.09.043
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发表时间：
2008-01-22
影响因子：
24
通讯作者：
Tang, W. H. Wilson
中科院分区：
文献类型：
--
作者：
Mullens, Wilfried;Abrahams, Zuhelr;Tang, W. H. Wilson
目的本研究旨在确定在急性失代偿性心力衰竭（ADHF）患者中，积极的利尿剂或血管扩张剂治疗是否会导致腹内压（IAP）的变化与肾功能的改善相关。背景IAP升高（>= 8 mm Hg）与腹内器官功能障碍相关。有潜在的腹水和内脏水肿引起IAP升高的ADHF.Methods连续40例患者入住一个专门的心力衰竭重症监护病房的管理ADHF与强化药物治疗进行了研究。在入院时和取出肺动脉导管前使用简单的经膀胱技术测量IAP。（平均年龄59 ± 13岁，平均左心室射血分数19 ± 9%，基线血清肌酐2.0 ± 0.9 mg/dI），平均基线IAP为8 ± 4 mm Hg，24例（60%）患者IAP升高。IAP升高与肾功能恶化相关（p = 0.009）。强化药物治疗导致血流动力学测量和IAP的改善。在基线IAP升高的患者中，观察到IAP降低与肾功能改善之间存在强相关性（r = 0.77，p < 0.001）。然而，IAP或肾功能的变化并没有相关的任何血流动力学variable.Conclusions IAP升高是普遍存在于ADHF患者，并与肾功能受损。在对ADHF进行强化药物治疗的情况下，IAP的变化与肾功能变化的相关性优于任何血流动力学变量。
Objectives This study sought to determine whether changes in intra-abdominal pressure (IAP) with aggressive diuretic or vasodilator therapy are associated with improvement in renal function in acute decompensated heart failure (ADHF).Background Elevated IAP (>= 8 mm Hg) is associated with intra-abdominal organ dysfunction. There is potential for ascites and visceral edema causing elevated IAP in patients with ADHF.Methods Forty consecutive patients admitted to a specialized heart failure intensive care unit for management of ADHF with intensive medical therapy were studied. The IAP was measured using a simple transvesical technique at time of admission and before removal of the pulmonary artery catheter.Results In our study cohort (mean age 59 +/- 13 years, mean left ventricular ejection fraction 19 +/- 9%, baseline serum creatinine 2.0 +/- 0.9 mg/dI), the mean baseline IAP was 8 +/- 4 mm Hg, with 24 (60%) patients having elevated IAP. Elevated IAP was associated with worse renal function (p = 0.009). Intensive medical therapy resulted in improvement in both hemodynamic measurements and IAP. A strong correlation (r = 0.77, p < 0.001) was observed between reduction in IAP and improved renal function in patients with baseline elevated IAP. However, changes in IAP or renal function did not correlate with changes in any hemodynamic variable.Conclusions Elevated IAP is prevalent in patients with ADHF and is associated with impaired renal function. In the setting of intensive medical therapy for ADHF, changes in IAP were better correlated with changes in renal function than any hemodynamic variable.