病态肥胖患者的胃和膀胱压力与腹内压相关,Journal of Clinical Monitoring and Computing

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病态肥胖患者的胃和膀胱压力与腹内压相关
Journal of Clinical Monitoring and Computing ( IF 2.0 ) Pub Date : 2021-06-17 , DOI: 10.1007/s10877-021-00728-7
Shadi Hamoud _{1,

2} , Siham Abdelgani ₃ , Michal Mekel _{2,

4} , Safa Kinaneh _{2,

5} , Ahmad Mahajna _{2,

4}

Affiliation

腹内压 (IAP) 影响心肺和血流动力学参数，可以通过测量胃或膀胱压力直接或间接测量。本研究的目的是调查病态肥胖患者的 IAP、胃压和膀胱压力之间的相关性，在两个位置的 IAP 水平正常和升高。同时，检查增加 IAP 和患者体位对血流动力学和呼吸参数的影响。包括 12 名接受腹腔镜减肥手术的患者。在患者处于仰卧位和 45° 抗特伦德伦堡倾斜后测量 IAP、胃压和膀胱压力。记录和评估平均吸气压力、吸气峰值压力和潮气量。仰卧位；直接测量的 IAP 为 9.1 ± 1.8 mmHg，而胃和膀胱分别为 10 ± 3.6 和 8.9 ± 2.9 mmHg。将 IAP 增加到 15 mmHg 导致胃压增加 17 ± 3.8 mmHg，膀胱压力增加 14.8 ± 3.9 mmHg。胃和膀胱压力与 IAP 密切相关（分别为 R = 0.875 和 0.847）。具有 45° 反特伦德伦堡倾斜度；直接测量的 IAP 为 9.4 ± 2.2 mmHg，胃和膀胱的压力分别为 10.8 ± 3.8 mmHg 和 9.2 ± 3.8 mmHg。将 IAP 增加到 15 mmHg 导致胃和膀胱压力分别升高到 16.6 ± 5.3 和 13.3 ± 4 mmHg。胃和膀胱压力与 IAP 具有良好的相关性（分别为 R = 0.843 和 0.819）。将患者体位从仰卧位更改为 45° 抗特伦德伦堡体位可降低平均和峰值吸气压力，并增加潮气量。病态肥胖患者的基础 IAP 较高。在 IAP 水平正常和升高时，IAP 与胃和膀胱压力呈正相关。机械通气病态肥胖患者的抗特伦德伦堡倾斜对呼吸参数产生有利影响。

试验注册：该研究在 NIH 登记处进行了回顾性注册。注册号待定。

"点击查看英文标题和摘要"

Gastric and urinary bladder pressures correlate with intra-abdominal pressure in patients with morbid obesity

Intra-abdominal pressure (IAP) affects cardio-respiratory and hemodynamic parameters and can be measured directly or indirectly by measuring gastric or urinary bladder pressure. The aim of this study was to investigate the correlation between IAP, gastric pressure and urinary bladder pressure in patients with morbid obesity, at normal and elevated levels of IAP in two positions. As well, to examine the effects of increasing IAP and patient's position on hemodynamic and respiratory parameters. Twelve patients undergoing laparoscopic bariatric surgery were included. IAP, gastric pressure, and urinary bladder pressure were measured while patients were in the supine position and after 45° anti-Trendelenburg tilt. Mean inspiratory pressure, peak inspiratory pressure, and tidal volume were recorded and assessed. In supine position; directly measured IAP was 9.1 ± 1.8 mmHg, compared to 10 ± 3.6 and 8.9 ± 2.9 mmHg in the stomach and bladder, respectively. Increasing IAP to 15 mmHg resulted in an increased gastric pressure of 17 ± 3.8 mmHg, and urinary bladder pressure of 14.8 ± 3.9 mmHg. Gastric and urinary bladder pressures strongly correlated with IAP (R = 0.875 and 0.847, respectively). With 45° anti-Trendelenburg tilt; directly measured IAP was 9.4 ± 2.2 mmHg, and pressures of 10.8 ± 3.8 mmHg and 9.2 ± 3.8 mmHg were measured in the stomach and the bladder, respectively. Increasing IAP to 15 mmHg resulted in elevating gastric and bladder pressures to 16.6 ± 5.3 and 13.3 ± 4 mmHg, respectively. Gastric and urinary bladder pressures had good correlation with IAP (R = 0.843 and 0.819, respectively). Changing patient position from supine to 45° anti-Trendelenburg position resulted in decreased mean and peak inspiratory pressures, and increased tidal volume. Basal IAP is high in patients with morbid obesity. IAP shows positive correlation to gastric and urinary bladder pressures at both normal and elevated levels of IAP. Anti-Trendelenburg tilt of mechanically ventilated morbidly obese patients resulted in favorable effects on respiratory parameters.

Trial Registration: The study was retrospectively registered in the NIH registry. Registration number is pending.

更新日期：2021-06-18

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