Intra-abdominal hypertension: Incidence and association with organ dysfunction during early septic shock
Intra-abdominal hypertension: Incidence and association with organ dysfunction during early septic shock
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DOI：
10.1016/j.jcrc.2007.12.013
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发表时间：
2008-12-01
影响因子：
3.7
通讯作者：
Hernandez, Glenn
中科院分区：
文献类型：
--
作者：
Regueira, Tomas;Bruhn, Alejandro;Hernandez, Glenn
目的：本文的目的是研究脓毒性休克（SS）患者在入住重症监护病房（ICU）的前72小时内腹腔内高压（IAH）的累积发生率，并确定IAH的存在和严重程度是否与脓毒症发病率和死亡率相关。材料和方法：81个连续的SS患者入院的学术大学医院的内科ICU（2005年1月至2006年1月）。腹腔内压（IAP）和腹腔灌注压（AAP）每6 h（间歇性）测量一次，持续72 h。在休克期间和整个研究期间，将腹腔内压记录为每天的最小值、平均值和最大值。如果IAP保持12 mm Hg或在整个研究期间，则诊断为腹内高压。如果连续2次测量的IAP保持12 mm Hg或更高，则诊断为腹腔内高压，并根据最新的共识定义（www.wsacs.org）进行分层。结果：根据最大和平均IAP值，67（82.7%）和62（76.5%）的患者在研究期间分别发生IAH。平均IAP值在整个研究期间保持稳定。手术组IAH发生率高于内科组（93%vs73%，P <0.009）。最大IAP呈正态分布，休克期间死亡者IAP水平显著较高（存活者，17.2 +/- 5.3死亡者。19.9+/- 5.6 mm Hg; P
Purpose: The objective of this article is to study the cumulative incidence of intra-abdominal hypertension (IAH) in septic shock (SS) patients during the first 72 hours of intensive care unit (ICU) admission and to determine if the presence and severity of IAH are associated with sepsis morbidity and mortality.Materials and Methods: Eighty-one consecutive SS patients admitted to a surgical-medical ICU of an academic university hospital (January 2005 to January 2006) were included. Intra-abdominal pressure (IAP) and abdominal perfusion pressure (AAP) were measured every 6 h (intermittently) for 72 h. Intra-abdominal pressure was registered as minimal, mean, and maximal values per day, during shock and throughout the study period. Intra-abdominal hypertension was diagnosed if IAP remained 12 mm Hg or throughout the study period. Intra-abdominal hypertension was diagnosed if IAP remained 12 mm Hg or higher on 2 consecutive measurements and stratified according to the most recent consensus definition (www.wsacs.org).Results: According to maximal and mean IAP values, 67 (82.7%) and 62 (76.5%) of the patients developed IAH during the study period, respectively. Mean IAP values remained stable throughout the Study Period. Surgical patients had a higher incidence of IAH than medical patients (93% vs 73%, P < .009). Maximal IAPs were normally distributed, with nonsurvivors exhibiting significantly higher IAP levels during shock (survivors, 17.2 +/- 5.3 nonsurvivors. 19.9 +/- 5.6 mm Hg; P