级麻醉学研究生.pptxVIP

会计学1级麻醉学研究生 Definition ACS: Symptomatic organ dysfunction that results from increased intra-abdominal pressure (IAP) . If the abdomen is closed, intra-abdominal pressure may rise to a level (25 cmH2O) where it leads to significant cardiovascular, respiratory, renal and cerebral dysfunction第1页/共17页 EtiologyMassive volume resuscitation in the leading cause of ACS. Inflammatory states with capillary leak, fluid sequestration, inadequate tissue perfusion, and lactic acidosis can develop ACS. Gastric overdistention following endoscopy has resulted in ACS.第2页/共17页 Pathophysiology● Causes of acutely increased IAPTrauma or intra abdominal hemorrhageAbdominal surgeryRetro-peritoneal hemorrhagePeritonitisLaparoscopy and pneumoperitoneumRepair of large incisional herniaAbdominal banding with postoperative Velcro belt to prevent incisional herniaMassive fluid resuscitation: ?5 L in 24 hrsIleus第3页/共17页 PathophysiologyThe IAP is usually 0 mmHg during spontaneous respiration, and is slightly positive in the patient on mechanical ventilation.IAP increases in direct relation to body mass index, and in one report, supine hospitalized patients had a mean baseline value of 6.5 mmHgThe compliance of the abdominal wall generally limits the rise in IAP but increases rapidly after a critical IAP.Critical IAP varies from patient to patient, based on abdominal wall compliance on perfusion gradient. IAH often defined as IAP 12mmHg第4页/共17页 Clinical ManifestationsCARDIAC ↗ vessel compression IAH → Intrathoracic pressure ? → ? Venous return ? SVR ↘ heart compression →? Cardiac output ?PCWP and CVP → Hypovolemia 第5页/共17页 Clinical Manifestations CENTRAL NERVOUS SYSTEM IAH → Intrathoracic pressure ? → Intravenous tension