Clinical Study Of Intra-abdominal Pressure Following Radical Resection Of Gastrointestinal Cancer

Objective:The major aims of this study were to investigate the changes of intra-abdominalpressure (IAP) and the incidence of intra-abdominal hypertension (IAH) in patientsundergoing radical resection of gastrointestinal cancer. A secondary aim was todetermine if the development of IAH was associate with poor outcome.Methods:120patients undergoing radical resection of gastrointestinal tumor were recruitedto this study in which intra-abdominal pressure was measured for the three consecutivedays. IAP was measured via a Foley bladder catheter. IAH defined as at least one IAPmeasured of12mmHg or more. The patients were divided into the IAH group andNon-IAH group according to the IAP value. The respiratory system, circulatory systemof blood, kidney and gastrointestinal function were selected to observe which can besignificant impacted by the IAH based on previous literature. So the following clinicalindicators were compared between the two groups, such as oxygen saturation, oxygenpartial pressure, respiratory rate, lactate of blood, heart rate, central venous pressure,volume of urea, creatinine and urea in blood, recovery time of bowel sound, recoverytime of fart and recovery time of defecation. And we also take some adverse events ofpostoperative to compare between the two groups, such as postoperative fever, woundpain, wound infection, disruption of wound, abdominal distension, lung infection,abdominal abscess, intestinal leakage.Results:1.The changes of IAP in patients undergoing undergoing major electiveabdominal surgery. The value of IAP on the day of post-operation is(5.25±1.47) mm Hg,7patients(5.8%)developed IAH; The value of IAP on the first postoperative day is (6.15±1.51)mm Hg,11patients (5.8%)developed IAH; The value of IAP on the secondpostoperative day is (5.05±1.48) mm Hg,8patients (6.7%)developed IAH; The valueof IAP on the third postoperative day is (4.46±1.49) mm Hg,4patients(3.3%)developed IAH. Finally, IAH had been measured in16patients, who wereclassified as IAH group(13.3%)，the remaining104patients were non-IAH group.2.The change of organ function following surgery.There was no significant difference in respiratory system between the two groupson the third day of postoperative. And there was no respiratory Failure case in bothgroups.There was no significant difference in circulatory system of blood between thetwo groups on the third day of postoperative. And there was no circulatory failure casein both groups.The output of urine in the IAH group on the third day of postoperative was1307±233ml, non-IAH group is1680±202ml, there was significant difference in statistics.The recovery time of bowel sound in IAH group is48.44±9.63h, the Non-IAHgroup in43.65±8.63h, there was statistical difference. The time of postoperative fartin IAH group is71.44±15.63h, the Non-IAH group is80.35±16.63h, there wasstatistical difference. The first defecate time after operation in Non-IAH group is94.22±17.01h, the IAH group is109.72±18.31h, there was also statistical difference. Wecan assume that the recovery time of gastrointestinal function is delay in IAH group.3. The adverse events of postoperative in the two groupsSeveral adverse events were selected to observe which may be impacted by IAHbased on previous literature. We can find the incidences of postoperative fever, woundinfection and wound pain were high in IAH group. Postoperative abdominal distention,lung infection, abdominal abscess, bleeding, wound dehiscence was no significantdifference between the two groups. In addition, The rate of overall adverse events inIAH group is higher than that in Non-group (68.8%＞29.8%).Conclusion:1.Intra-abdominal pressure would increase on the earlier day in patients whoundergoing radical resection of gastrointestinal cancer, especially in the firstpostoperative day. 2.The development of intra-abdominal hypertension was associated with delay ofrecovery of gastrointestinal function, but there was no significant difference inrespiratory system, circulatory system of blood and kidney function between the twogroups.3.There was a relationship between intra abdominal hypertension withpostoperative adverse,such as postoperative fever, wound infection and wound pain.