Clinical Application of Intra-Abdominal Pressure Measure in Patients with Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Chenghua , GE Liang , HE Qian

*Department of General Surgery, The 180th Hospital of PLA, Quanzhou 362000, Fujian Province, China;

Corresponding author：

Keywords：

Liver transplantation; After operation; Intra-abdominal pressure; Monitoring

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Objective To investigate the clinical significance of intra-abdominal pressure measure in patients with liver transplantation by summarizing the data of 143 cases. Methods Intra-abdominal pressure was indirectly measured by urinary bladder pressure. Intra-abdominal pressure over 10 cm H2O (1 cm H2O=0.098 kPa) was regarded as intra-abdominal hypertension (IAH), and 10＜pressure≤15 cm H2O as gradeⅠ, 15＜pressure≤25 cm H2O as grade Ⅱ, 25＜pressure≤35 cm H2O as grade Ⅲ, over 35 cm H2O as grade Ⅳ. The parameters of circulatory system, respiratory system, renal function and the postoperative intra-abdominal pressure for 7 days were recorded to every patient, and the parameters of each grade IAH group were contrasted with non-IAH group. Results
Among 143 cases, 45 cases were IAH (31.5%), in which 18 cases belonged to grade Ⅰ, 13 cases belonged to grade Ⅱ, 11 cases belonged to grade Ⅲ, while 3 cases belonged to grade Ⅳ. Compared with those in non-IAH group, SCr and BUN significantly increased (P＜0.05, P＜0.01), PaO2 significantly decreased (P＜0.05, P＜0.01) in each grade IAH group; Respiratory frequency (RF), heart rate (HR) and PaCO2 significantly increased (P＜0.05, P＜0.01) in some grade IAH group (HR in grade Ⅱ, Ⅲ and Ⅳ, RF and PaCO2 in grade Ⅲ and Ⅳ). Conclusions Intra-abdominal hypertension would affect liver function by impaired circulatory, respiratory and renal function. So, it is necessary to measure intra-abdominal pressure for patients after liver transplantation, which can help to choose appropriate treatment.

Citation： ZHANG Chenghua,GE Liang,HE Qian. Clinical Application of Intra-Abdominal Pressure Measure in Patients with Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(12): 982-986. doi: Copy

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2.	Hong JJ, Cohn SM, Perez JM, et al. Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Br J Surg, 2002； 89(5): 591-596.
3.	Moore AF, Hargest R, Martin M, et al. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Br J Surg, 2004； 91(9): 1102-1110.
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6.	黎介寿. 急性腹腔间室综合征及其护理 [Ｊ]. 中华护理杂志, 2007； 42(3): 209-211.
7.	Sabiston Ed. Textbook of surgery [M]. 17th eds. Philadelphia: Saunders. 2004: 628-630.
8.	Saggi BH, Sugerman HJ, Ivatury RR, et al. Abdominal co-mpartment syndrome [Ｊ]. J Trauma, 1998； 45(3): 597-609.
9.	吴在德. 肝疾病 [A]. 见: 吴在德主编. 外科学 [M]. 第5版. 北京: 人民卫生出版社, 2000: 582-585.
10.	Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance [Ｊ]. Arch Surg, 1995； 130(5): 544-547.
11.	Sieh KM, Chu KM, Wong J. Intra-abdominal hypertension and abdominal compartment syndrome [Ｊ]. Langenbecks Arch Surg, 2001； 386(1): 53-61.
12.	王大庆, 葛颖, 龚宗炼, 等. 不同水平腹内压对猪血流动力学和氧代谢指标的影响 [Ｊ]. 中国普外基础与临床杂志, 2008； 15(5): 333-336.
13.	Joynt GM, Ramsay SJ, Buckley TA. Intra-abdominal hypertension-implications for the intensive care physician [Ｊ]. Ann Acad Med Singapore, 2001； 30(3): 310-319.
14.	Schachtrupp A, Graf J, Tons C, et al. Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension [Ｊ]. J Trauma, 2003； 55(4): 734-740.
15.	Blevins DV, Khanduja KS. Abdominal compartment syndr-ome with massive lower-extremity edema caused by colonic obstruction and distention [Ｊ]. Am Surg, 2001； 67(5): 451-453.
16.	Yokoyama Y, Alterman DM, Sarmadi AH, et al. Hepatic vascular response to elevated intraperitoneal pressure in the rat [Ｊ]. J Surg Res, 2002； 105(2): 86-94.
17.	Nakatani T, Sakamoto Y, Kaneko I, et al. Effects of intra-abdominal hypertension on hepatic energy metabolism in a rabbit model [Ｊ]. J Trauma, 1998； 44(3): 446-453.
18.	Loi P, De Backer D, Vincent JL. Abdominal compartment syndrome [Ｊ]. Acta Chir Belg, 2001； 101(2): 59-64.
19.	Doty JM, Saggi BH, Blocher CR, et al. Effects of increased renal parenchymal pressure on renal function [Ｊ]. J Trauma, 2000； 48(5): 874-877.
20.	Doty JM, Saggi BH, Sugerman HJ, et al. Effect of increased renal venous pressure on renal function [Ｊ]. J Trauma, 1999； 47(6): 1000-1003.
21.	Sugrue M, Jones F, Deane SA, et al. Intra-abdominal hypertension is an independent cause of postoperative renal impairment [Ｊ]. Arch Surg， 1999； 134(10): 1082-1085.
22.	Hunter JD, Damani Z. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Anaesthesia, 2004； 59(9): 899-907.
23.	Biancofiore G, Bindi L, Romanlli AM, et al. Renal failure and abdominal hypertension after liver transplantation: determination of critical intra-abdominal pressure [Ｊ]. Liver Transpl, 2002； 8(12): 1175-1181.
24.	Biancofiore G, Bindi ML, Romanelli AM, et al. Postoperative intra-abdominal pressure and renal function after liver transplantation [Ｊ]. Arch Surg， 2003； 138(7): 703-706.
25.	杨新平, 姜洪池. 腹腔内高压与腹腔间室综合征 [Ｊ]. 中国普外基础与临床杂志, 2002； 9(6): 451-453.
26.	Offner PJ, de Souza AL, Moore EE, et al. Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma [Ｊ]. Arch Surg, 2001； 136(6): 676-681.

1. Grubben AC, van Baardwijk AA, Broering DC, et al. Pathophysiology and clinical significance of the abdominal compartment syndrome [Ｊ]. Zentralbl Chir, 2001； 126(8): 605-609.
2. Hong JJ, Cohn SM, Perez JM, et al. Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Br J Surg, 2002； 89(5): 591-596.
3. Moore AF, Hargest R, Martin M, et al. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Br J Surg, 2004； 91(9): 1102-1110.
4. Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement： validity and methodology [Ｊ]. J Trauma, 2001； 50(2): 297-302.
5. 万勇, 葛颖, 王大庆, 等. 膀胱压、胃内压与腹内压的相关性研究 [Ｊ]. 中国普外基础与临床杂志, 2003； 10(4): 383-384.
6. 黎介寿. 急性腹腔间室综合征及其护理 [Ｊ]. 中华护理杂志, 2007； 42(3): 209-211.
7. Sabiston Ed. Textbook of surgery [M]. 17th eds. Philadelphia: Saunders. 2004: 628-630.
8. Saggi BH, Sugerman HJ, Ivatury RR, et al. Abdominal co-mpartment syndrome [Ｊ]. J Trauma, 1998； 45(3): 597-609.
9. 吴在德. 肝疾病 [A]. 见: 吴在德主编. 外科学 [M]. 第5版. 北京: 人民卫生出版社, 2000: 582-585.
10. Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance [Ｊ]. Arch Surg, 1995； 130(5): 544-547.
11. Sieh KM, Chu KM, Wong J. Intra-abdominal hypertension and abdominal compartment syndrome [Ｊ]. Langenbecks Arch Surg, 2001； 386(1): 53-61.
12. 王大庆, 葛颖, 龚宗炼, 等. 不同水平腹内压对猪血流动力学和氧代谢指标的影响 [Ｊ]. 中国普外基础与临床杂志, 2008； 15(5): 333-336.
13. Joynt GM, Ramsay SJ, Buckley TA. Intra-abdominal hypertension-implications for the intensive care physician [Ｊ]. Ann Acad Med Singapore, 2001； 30(3): 310-319.
14. Schachtrupp A, Graf J, Tons C, et al. Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension [Ｊ]. J Trauma, 2003； 55(4): 734-740.
15. Blevins DV, Khanduja KS. Abdominal compartment syndr-ome with massive lower-extremity edema caused by colonic obstruction and distention [Ｊ]. Am Surg, 2001； 67(5): 451-453.
16. Yokoyama Y, Alterman DM, Sarmadi AH, et al. Hepatic vascular response to elevated intraperitoneal pressure in the rat [Ｊ]. J Surg Res, 2002； 105(2): 86-94.
17. Nakatani T, Sakamoto Y, Kaneko I, et al. Effects of intra-abdominal hypertension on hepatic energy metabolism in a rabbit model [Ｊ]. J Trauma, 1998； 44(3): 446-453.
18. Loi P, De Backer D, Vincent JL. Abdominal compartment syndrome [Ｊ]. Acta Chir Belg, 2001； 101(2): 59-64.
19. Doty JM, Saggi BH, Blocher CR, et al. Effects of increased renal parenchymal pressure on renal function [Ｊ]. J Trauma, 2000； 48(5): 874-877.
20. Doty JM, Saggi BH, Sugerman HJ, et al. Effect of increased renal venous pressure on renal function [Ｊ]. J Trauma, 1999； 47(6): 1000-1003.
21. Sugrue M, Jones F, Deane SA, et al. Intra-abdominal hypertension is an independent cause of postoperative renal impairment [Ｊ]. Arch Surg， 1999； 134(10): 1082-1085.
22. Hunter JD, Damani Z. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Anaesthesia, 2004； 59(9): 899-907.
23. Biancofiore G, Bindi L, Romanlli AM, et al. Renal failure and abdominal hypertension after liver transplantation: determination of critical intra-abdominal pressure [Ｊ]. Liver Transpl, 2002； 8(12): 1175-1181.
24. Biancofiore G, Bindi ML, Romanelli AM, et al. Postoperative intra-abdominal pressure and renal function after liver transplantation [Ｊ]. Arch Surg， 2003； 138(7): 703-706.
25. 杨新平, 姜洪池. 腹腔内高压与腹腔间室综合征 [Ｊ]. 中国普外基础与临床杂志, 2002； 9(6): 451-453.
26. Offner PJ, de Souza AL, Moore EE, et al. Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma [Ｊ]. Arch Surg, 2001； 136(6): 676-681.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Application of Intra-Abdominal Pressure Measure in Patients with Liver Transplantation

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