腹腔压力(IAP)测定与腹腔间隔室综合征(ACS)(1)

Kidneys: Reduced kidney perfusion and urine production results in inability to mobilize fluids and increased rates of renal insufficiency/failure.
As IAP exceeds 15 to 20 mm Hg capillary blood flow is dramatically reduced, leading to anaerobic metabolism, increased cytokine production and exacerbation of capillary permeability (worsening bowel edema). At IAP levels approaching 20 mm Hg venous return to the heart is impaired reducing cardiac output. Decreases in systemic blood flow (CO) compounds the insult of direct tissue ischemia perpetuating the vicious cycle.
（世界腹腔间隔室综合征协会WSACS 2007.02）
Intra-Abdominal Pressure
Most critically ill patients have a significant systemic inflammatory response (SIRS) that triggers the release of cytokines leading to capillary permeability and interstitial edema. Abdominal viscera are particularly vulnerable as tissue edema worsens with the third spacing of resuscitative fluid. As visceral edema worsens intra-abdominal pressure (IAP) increases. As IAP increases perfusion to abdominal organs decreases resulting in compromise to visceral blood flow and tissue ischemia. Tissue ischemia then perpetuates further cytokine release and worsening systemic inflammation thus initiating the vicious cycle.
Intra-来自百度文库bdominal Hypertension
Intra-Abdominal Hypertension (IAH) is defined as Intra-Abdominal Pressure (IAP) above 12 mm Hg . At which point significant tissue perfusion problems arise, which can lead to early organ dysfunction. An IAP level over 20 mm Hg typically causes organ failure and is called Abdominal Compartment Syndrome
腹腔压力（intra-abdominal pressure，（IAP） 测定与腹腔间隔室综合征（abdominal
compartment syndrome ACS）
青岛市市立医院ICU曲彦
概述

1984年，Kron等第一次提出了ACS这一名词，用来 描述腹内压力增高后所致的心血管、肺、肾、胃肠及 颅脑等多器官系统的功能障碍(而对腹内压和其病理生 理学的描述可追溯到十九世纪的论文） 。
90年代始开展了有关ACS的重大临床研究 。 国外文献报道ACS死亡率高达29%～62%。 IAH是ICU患者病死率的独立影响因素，与器官功 能衰竭及ICU滞留时间息息相关。


相关概念

腹腔高压(intra-abdominal hypertension ,IAH) ：指持续或反复的腹腔 压力（intra-abdominal pressure， IAP）病理性升高(≥12mmHg)
Lungs: IAP pushes diaphragms into chest, raising intrathoracic pressure causing an increase in barotrauma, hypercarbia and hypoxemia. This results in increased time on the ventilator with increases in VAP. Brain: IAP elevation can directly contribute to ICP elevation.
Intestines: IAP compromises intestinal blood flow resulting in ischemia, necrosis and multisystem organ failure.
Heart: Cardiac monitoring, including CVP and PCWP, are artificially elevated by IAP making them difficult to interpret in the IAH setting.
腹腔间隔室综合征 （各种原因）腹腔压力（IAP）出现持续升高并且>２０mmHg，伴 或不伴有腹腔灌注压（abdominal perfusion pressure，APP）＜ 60mmHg，同时合并有IAH相关的新的器官功能障碍/衰竭。 危重患者的正常腹内压(IAP)大约是5-7 mmHg



腹腔灌注压(APP ) ：平均动脉压-腹内压 APP≥60 mmHg及以上具有良好的预后判断价值。