Effects of Different Levels of Intra-Abdominal Pressure on Hemodynamics and Oxygen Metabolism in Pig_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Daqing , GE Ying , GONG Zonglian , WAN Yong

Intensive Care Unit, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China;

Corresponding author：

Keywords：

Intra-abdominal pressure; 　　Hemodynamics; 　　Oxygen metabolism

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Objective To study the effects of different levels of intra-abdominal pressure （IAP） on hemodynamics and oxygen metabolism in pig and to find the parameters early reflecting hemodynamics and oxygen metabolism of intra-abdominal hypertension （IAH）. Methods Fifteen pigs were anaesthetized, and trachea intubation and transfemoral cannula were performed then. Swan-Ganz catheters were inserted to pulmonary artery via internal jugular vein, and aeroperitoneum was set up by airing CO2. These pigs were randomly divided into three groups (5 pigs in each group) according to different levels of IAP （IAP10, IAP20, IAP30）. Hemodynamics and oxygen metabolism values were observed and recorded before airing, 6, 12, 18 and 24 hours after airing, respectively. Results There was no remarkable changes of hemodynamics and oxygen metabolism values in IAP10 group （P gt;0.05）； When the IAP level reached 20 cm H2O, there was significant elevation （P＜0.01) in artery blood lacticacid （ABL）, and mixed venous oxygen saturation （SvO2） decreased significantly （P＜0.05) at 24 hours. When the IAP level reached 30 cm H2O, HR began to increase significantly at 18 hours after airing （P＜0.05). After 24 hours, all the indices of hemodynamics and oxygen metabolism were either significantly increased or decreased in IAP30 group. Two pigs in the group of IAP30 died during 24 hours after airing, while other pigs survived. Conclusion This study demonstrates that the hemodynamics and oxygen metabolism values begin to change in pigs when the IAP level reaches 20 cm H2O, and high level of IAP that lasted for 24 hours shows deterioration of hemodynamic and oxygenation levels. The indices of SvO2 and ABL can early reflect tissue oxygenation in IAH.

Citation： WANG Daqing,GE Ying,GONG Zonglian,WAN Yong. Effects of Different Levels of Intra-Abdominal Pressure on Hemodynamics and Oxygen Metabolism in Pig. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(5): 333-336. doi: Copy

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1. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration [Ｊ]. Ann Surg, 1984; 199(1)∶28.
2. Serpytis M, Ivaskevicius J. Intra-abdominal hypertension and multiple organ dysfunction syndrome [Ｊ]. Medicina (Kaunas), 2005; 41(11)∶903.
3. Sullivan KM, Battey PM, Miller JS, et al. Abdominal compartment syndrome after mesenteric revascularization [Ｊ]. J Vasc Surg, 2001; 34(3)∶559.
4. 孙华, 翁卫群, 陈峰, 等. 腹内压监测在多器官功能障碍综合征防治中的意义 [Ｊ]. 中国危重病急救医学, 2004; 16(11)∶687.
5. Bailey J, Shapiro MJ. A Abdominal compartment syndrome [Ｊ]. Crit Care, 2000; 4(1)∶23.
6. Morken J, West MA. Abdominal compartment syndrome in the intensive care unit [Ｊ]. Curr Opin Crit Care, 2001; 7(4)∶268.
7. 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.
8. Johna S, Taylor E, Brown C, et al. Abdominal compartment syndrome: does intra-cystic pressure reflect actual intr-abdominal pressure? A prospective study in surgical patients [Ｊ]. Crit Care, 1999; 3(6)∶135.
9. Burrows R, Edington J, Robbs JV. A wolf in wolf’s cloth-ingthe abdominal compartment syndrome [Ｊ]. S Afr Med J, 1995; 85(1)∶46.
10. 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.
11. Ivy ME, Atweh NA, Palmer J, et al. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients [Ｊ]. J Trauma, 2000; 49(3)∶387.
12. 肖杰, 蔡宝仁. 小儿烧伤并发腹腔间隙综合征一例 [Ｊ]. 中华烧伤杂志, 2001; 17(2)∶124.
13. 王大庆，万勇. 腹内压升高对呼吸系统的影响 [Ｊ]. 四川医学， 2003; 24（8）∶817.
14. Pelosi P, D’Onofrio D, Chiumello D, et al. Pulmonary and extrapulmonary acute respiratory distress syndrome are different [Ｊ]. Eur Respir J Suppl, 2003; 42∶48s.
15. 万勇，胡建华，王大庆，等. 腹内压升高对血流动力学的影响 [Ｊ]. 中国急救医学, 2004; 24（11）∶845.
16. Barnes GE, Laine GA, Diam PY, et al. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure [Ｊ]. Am J Physiol, 1985; 248(2 Pt 2)∶R208.
17. 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.
18. Ebaveye Y, Bertieaux M, Malbrain M. Simultaneous measurement of intra-abdominal pressure and regional CO2 via a gastric tonometer [Ｊ]. Intensive Care Med, 2000; 26∶S324.
19. Sugrue M, Jones F, Lee A, et al. Intraabdominal pressure and gastric intramucosal pH: is there an association? [Ｊ]. World J Surg， 1996; 20(8)∶988.
20. Ivatury RR, Porter JM, Simon RJ, et al. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome [Ｊ]. J Trauma， 1998; 44(6)∶1016.
21. Hunter JD, Damani Z. Intra-abdominal hypertension and the abdominal compartment syndrome [Ｊ]. Anaesthesia， 2004; 59(9)∶899.
22. 张耀频，孙培吾，童萃文，等. 中心静脉与混合静脉血氧饱和度监测术后血容量变化的比较 [Ｊ]. 中国胸心血管外科临床杂志， 1998； 5（4）∶196.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effects of Different Levels of Intra-Abdominal Pressure on Hemodynamics and Oxygen Metabolism in Pig

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