H. ELatroush , N. Abed , A. Metwaly , M. Afify , M. Hussien
{"title":"多脏器功能障碍危重患者腹腔灌注压对内脏循环的影响","authors":"H. ELatroush , N. Abed , A. Metwaly , M. Afify , M. Hussien","doi":"10.1016/j.ejccm.2015.12.001","DOIUrl":null,"url":null,"abstract":"<div><p>Ongoing studies investigating the intra abdominal pressure (IAP) shifted the belief of mesenteric circulation not to be only a culprit of decreased arterial hypoperfusion, but also other hydrostatic forces may impose its perfusion and may also act directly on the tissues. While the gut theory stated the engine of multiorgan dysfunction syndrome (MODS), abdominal perfusion pressure (APP) was examined in MODS patients to assess mesenteric circulation instead of merely abdominal arterial hypoperfusion.</p></div><div><h3>Aim</h3><p>We aimed to study the correlation between increased fluid gain and low APP and increased risk for visceral organ hypoperfusion.</p></div><div><h3>Patients and methods</h3><p>106 MODS patients were studied retrospectively, and included if a SOFA subscore of ⩾2 was recorded in at least 2 organ systems, routine laboratory investigations, lactate, fluid gain was defined as the cumulative positive fluid gained during resuscitation. Vital signs were recorded and IAP (measured through UB, closed loop small volume technique) and APP which is derived from the equation (mean arterial blood pressure MAP – intraabdominal pressure IAP) and Liver SOFA subscore were calculated as indirect markers of mesenteric hypoperfusion.</p></div><div><h3>Results</h3><p>The APP on admission was negatively correlated with lactate and fluid gain (<em>r</em> <!-->=<!--> <!-->−0.388 and −.225 <em>P</em> <!-->=<!--> <!-->0.0001 and .021 respectively).</p><p>The lower the APP, the worse the Liver SOFA subscore (85.3<!--> <!-->±<!--> <!-->14.2, 75.7<!--> <!-->±<!--> <!-->15.3, 73.1<!--> <!-->±<!--> <!-->24.6, 76.6<!--> <!-->±<!--> <!-->16.8 and 66<!--> <!-->±<!--> <!-->17.1 <em>p</em> 0.012), SOFA and lactate were the significant predictors for APP.</p></div><div><h3>Conclusion</h3><p>Low APP and positive fluid gain are associated with deteriorating visceral circulation manifested by high lactate levels and deteriorating liver function.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":"3 2","pages":"Pages 63-67"},"PeriodicalIF":0.3000,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2015.12.001","citationCount":"6","resultStr":"{\"title\":\"The effect of the abdominal perfusion pressure on visceral circulation in critically ill patients with multiorgan dysfunction\",\"authors\":\"H. ELatroush , N. Abed , A. Metwaly , M. Afify , M. Hussien\",\"doi\":\"10.1016/j.ejccm.2015.12.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Ongoing studies investigating the intra abdominal pressure (IAP) shifted the belief of mesenteric circulation not to be only a culprit of decreased arterial hypoperfusion, but also other hydrostatic forces may impose its perfusion and may also act directly on the tissues. While the gut theory stated the engine of multiorgan dysfunction syndrome (MODS), abdominal perfusion pressure (APP) was examined in MODS patients to assess mesenteric circulation instead of merely abdominal arterial hypoperfusion.</p></div><div><h3>Aim</h3><p>We aimed to study the correlation between increased fluid gain and low APP and increased risk for visceral organ hypoperfusion.</p></div><div><h3>Patients and methods</h3><p>106 MODS patients were studied retrospectively, and included if a SOFA subscore of ⩾2 was recorded in at least 2 organ systems, routine laboratory investigations, lactate, fluid gain was defined as the cumulative positive fluid gained during resuscitation. Vital signs were recorded and IAP (measured through UB, closed loop small volume technique) and APP which is derived from the equation (mean arterial blood pressure MAP – intraabdominal pressure IAP) and Liver SOFA subscore were calculated as indirect markers of mesenteric hypoperfusion.</p></div><div><h3>Results</h3><p>The APP on admission was negatively correlated with lactate and fluid gain (<em>r</em> <!-->=<!--> <!-->−0.388 and −.225 <em>P</em> <!-->=<!--> <!-->0.0001 and .021 respectively).</p><p>The lower the APP, the worse the Liver SOFA subscore (85.3<!--> <!-->±<!--> <!-->14.2, 75.7<!--> <!-->±<!--> <!-->15.3, 73.1<!--> <!-->±<!--> <!-->24.6, 76.6<!--> <!-->±<!--> <!-->16.8 and 66<!--> <!-->±<!--> <!-->17.1 <em>p</em> 0.012), SOFA and lactate were the significant predictors for APP.</p></div><div><h3>Conclusion</h3><p>Low APP and positive fluid gain are associated with deteriorating visceral circulation manifested by high lactate levels and deteriorating liver function.</p></div>\",\"PeriodicalId\":31233,\"journal\":{\"name\":\"Egyptian Journal of Critical Care Medicine\",\"volume\":\"3 2\",\"pages\":\"Pages 63-67\"},\"PeriodicalIF\":0.3000,\"publicationDate\":\"2015-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.ejccm.2015.12.001\",\"citationCount\":\"6\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Egyptian Journal of Critical Care Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2090730315000274\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Egyptian Journal of Critical Care Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2090730315000274","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 6
摘要
正在进行的关于腹内压(IAP)的研究改变了人们的观点,即肠系膜循环不仅是动脉灌注不足减少的罪魁祸首,而且其他流体静力也可能施加其灌注,并可能直接作用于组织。虽然肠道理论指出了多器官功能障碍综合征(MODS)的病因,但在MODS患者中检测腹部灌注压(APP)来评估肠系膜循环,而不仅仅是腹部动脉灌注不足。目的:研究液体增加与低APP及内脏器官低灌注风险增加之间的关系。患者和方法对106名MODS患者进行回顾性研究,如果在至少2个器官系统中记录了大于或等于2的SOFA评分,则将其包括在内,常规实验室调查,乳酸,液体增加被定义为复苏期间获得的累积阳性液体。记录生命体征,并计算IAP(通过UB,闭环小容量技术测量)、APP(平均动脉压MAP -腹内压IAP)和肝SOFA评分作为肠系膜灌流不足的间接指标。结果入院时APP与乳酸和液体增加呈负相关(r = - 0.388和- 0.225)P分别= 0.0001和0.021)。APP越低,肝脏SOFA评分越差(85.3±14.2,75.7±15.3,73.1±24.6,76.6±16.8和66±17.1 p 0.012), SOFA和乳酸水平是预测APP的重要指标。结论APP低和液体增加阳性与内脏循环恶化相关,表现为高乳酸水平和肝功能恶化。
The effect of the abdominal perfusion pressure on visceral circulation in critically ill patients with multiorgan dysfunction
Ongoing studies investigating the intra abdominal pressure (IAP) shifted the belief of mesenteric circulation not to be only a culprit of decreased arterial hypoperfusion, but also other hydrostatic forces may impose its perfusion and may also act directly on the tissues. While the gut theory stated the engine of multiorgan dysfunction syndrome (MODS), abdominal perfusion pressure (APP) was examined in MODS patients to assess mesenteric circulation instead of merely abdominal arterial hypoperfusion.
Aim
We aimed to study the correlation between increased fluid gain and low APP and increased risk for visceral organ hypoperfusion.
Patients and methods
106 MODS patients were studied retrospectively, and included if a SOFA subscore of ⩾2 was recorded in at least 2 organ systems, routine laboratory investigations, lactate, fluid gain was defined as the cumulative positive fluid gained during resuscitation. Vital signs were recorded and IAP (measured through UB, closed loop small volume technique) and APP which is derived from the equation (mean arterial blood pressure MAP – intraabdominal pressure IAP) and Liver SOFA subscore were calculated as indirect markers of mesenteric hypoperfusion.
Results
The APP on admission was negatively correlated with lactate and fluid gain (r = −0.388 and −.225 P = 0.0001 and .021 respectively).
The lower the APP, the worse the Liver SOFA subscore (85.3 ± 14.2, 75.7 ± 15.3, 73.1 ± 24.6, 76.6 ± 16.8 and 66 ± 17.1 p 0.012), SOFA and lactate were the significant predictors for APP.
Conclusion
Low APP and positive fluid gain are associated with deteriorating visceral circulation manifested by high lactate levels and deteriorating liver function.
期刊介绍:
The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine. The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care. The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.