Observation of the change rule of heart rate, blood pressure and respiratory changes in patients with malignant ascites water-borne abdominal compartment syndrome undergoing early catheter decompression

Abstract

Objective To investigate the relationship between ascites drainage and heart rate, blood pressure and respiratory changes in patients with malignant ascites water-borne abdominal compartment syndrome (MAACS) undergoing early catheter decompression. Methods The clinical data of 22 patients with MAACS in the Department of Tumor Surgery, Affiliated Hospital of Shanxi Datong University from June 2012 to June 2017 were investigated retrospectively in cross-section. There were 13 males and 9 females, aged 45-74 (56.44 ± 4.46) years. There were 6 cases of hepatocellular carcinoma, 2 cases of gastric cancer, 1 case of colon cancer, 2 cases of rectal cancer, 1 case of pancreatic cancer, 1 case of cholangiocarcinoma, 6 cases of ovarian cancer, 2 cases of cervical cancer, and 1 case of malignant ascites, without finding the primary lesion. All patients were treated with early intraperitoneal decompression before abdominal drainage. In the process of ascites drainage, the pressure in abdominal cavity was measured before and after the drainage of ascitic fluid for every 500 mL. intra-abdominal pressure, heart rate, respiration and blood pressure were recorded synchronously. The changes of heart rate, blood pressure and respiration were observed. The correlation between abdominal drainage and heart rate, blood pressure and respiration was analyzed by linear regression. Results All the 22 patients were successfully treated by abdominal catheter decompression, and the time of drainage and drainage was 3-6 (4.32 ± 0.54) hours. The ascites volume was 4 000-6 900 (5 260 ± 610) mL. In the decompression process of abdominal drainage, the abdominal pressure decreased and the number of breathing decreased when the drainage flow was more than 1 500 mL (all P values< 0.05) comparing with that before ascites drainage. The heart rate decreased when the drainage flow was more than 1 000 mL (all P values<0.05). Simple linear regression analysis showed that abdominal drainage was correlated with heart rate and respiration (r=0.952, 0.888, all P values<0.05). Linear regression analysis showed: =-0.004 57 Xabdominal drainage(mL)+ 119.0, =-0.00343 Xabdominal drainage(mL)+ 35.8. Within 24 hours after decompression, heart rate, blood pressure and respiration were stable in 19 cases, decreased blood pressure in 3 cases, increased heart rate again, 2 cases were recovered by rehydration and boosting blood pressure, and 1 case gave up treatment and died. Conclusions Early catheter decompression is safe for the treatment of MAACS. With the increase of abdominal drainage, heart rate and respiration decrease gradually, and blood pressure remains stable. The changes of heart rate, respiration and blood pressure should be closely observed within 24 hours after decompression. Key words: Ascites; malignant ascites-induced abdominal compartment syndrome; Carcinoma; Intra-abdominal hypertension; Abdominal pressure