The Research Progress Of Intra-abdominal Hypertension And Abdominal Compartment Syndrome

Intra-abdominal hypertension (IAH) and Abdominal Compartment Syndrome (ACS) are increasingly considered be important. The investigation indicated that many doctors or patients under a condition of surgical seriously injured disease still have not enough knowledge about ACS. Its pathogenesis has not yet been expounded. At present studies think that it related to the oedema of damage organ and increasing extracellular fluid , which caused by direct-pressure,ischemical reperfusion injury,the release of vasoactive substance,the increasing vasopermeability and oxyradical.ACS has a large influence on the bloodstream of whole body systems and inter-abdominal organs, such as gastrointestinal tract,liver,kidney,lung,abdominal wall,cardiovascular system,central nervous system. The World Society of the Abdominal Compartment Syndrome announced the newest diagnosis standard in 2006. IAH is defined by a sustained or repeated pathologic elevation of IAP≥12mmHg. Abdominal compartment syndrome (ACS) is defined as a sustained IAP>20mmHg(with or without an APP[Abdominal perfusion pressure]<60mmHg) that is associated with new organ dysfunction/failure. IAH is graded as follows: Grade I: IAP 12-15 mmHg, Grade II: IAP 16-20 mmHg, Grade III: IAP 21- 25 mmHg, Grade IV: IAP > 25 mmHg.The diagnosis of ACS depend on the measure of IAP, not clinical diagnosis. There are two methods including direct way and indirect way. Direct way is not usually used because of its wound and complex. Indirect way including via bladder,via stomach,via inferior vena cava is widespread used. The bladder way which is highly similar to IAP is considered as the golden standard. The development of ACS that is usually concealed, which is covered by the primary disease and other phenomenon, shoud be payed much attention by surgeons. The IAP measured via bladder and pH value of stomach and intestines mucous membrane are the early sensitive target.There are two methods to treat with ACS: the non-surgery treatment and surgery treatment. The non-surgery treatment used for Grade I and Grade II, which includs generally treatment and Chinese medicine treatment, is proved effective for the early patients. Surgery treatment used for Grade III and Grade IV, including decompression procedure(temporary abdominal closure,accurate abdominal closure), plays a important part in improving symptom,reversing organ function and raising patient's survival rate. The earlier taking decompression procedure, the higher survival percentage.