腹腔间隔室综合征38例临床分析
The clinical analysis of abdominal interval syndrome in 38 cases
-
摘要: 目的:探讨腹腔间隔室综合征(ACS)的临床特点及诊治措施。方法:38例ACS患者根据病情分为保守治疗组8例,手术治疗组30例。观察2组临床症状和发生并发症、病死、治愈及腹内压变化的情况。结果:38例患者总并发症发生率42.1%,总病死率31.6%,总治愈率68.4%。保守治疗组发生并发症3例,手术治疗组并发症13例;保守治疗组病死3例,手术治疗组病死9例;保守治疗组治愈5例,手术治疗组治愈21例,2组差异均无统计学意义(P=1.000)。38例均出现ACS体征,采用膀胱内测量法测得腹内压稳定升高且20 mmHg,多伴有休克、急性呼吸窘迫综合征、多器官功能障碍综合征,其中26例出现2个或2个以上器官功能障碍。结论:正确地把握ACS的治疗时机与指征,合理选择治疗方式,对预后至关重要。Abstract: Objective: To explore the clinical characteristics，diagnosis and treatment measures of abdominal compartment syndrome (ACS) . Methods: Thirty-eight patients with ACS were divided into surgical treatment group (30 cases) and conservative treatment group(8 cases) according to the patient's condition. The complications，death，cured, intra-abdominal pressure and clinical symptoms were compared. results: The total incidence rate of complication, fatality rate and cure rate were 42. 1%，31. 6% and 68. 4%, respectively. Complications in 3 cases and 13 cases were found in conservative treatment group and surgical treatment group, respectively. Death in 3 cases and 9 cases were found in conservative treatment group and surgical treatment group, respectively. Cure in 5 cases and 21 cases were found in conservative treatment group and surgical treatment group, respectively, the differeces of which were not statistically significant(P = 1. 000) . ACS signs were found in 38 cases, intra-abdominal pressure(more than 20 mmHg) elevated stability by cystometry, accompanied with shock, acute respiratory distress syndrome and multiple organ dysfunction syndrome in more cases. Two or more organ dysfunction in 26 cases were found. Conclusions: Mastering appropriate treatment timing, indications and method are vital to the prognosis of ACS.
-
Key words:
- abdominal compartment syndrome /
- surgery /
- treatment
-
[2] Moore AF，Hargest r，Matrin M，et al. Intra-abdominal hypertension and the abdominal compartment syndrome[J]. br J Surg，2004, 91(9): 1102-1110. [2] Loftus IM，Thompson MM. The abdominal compartment syndrome following aortic surgery[J]. Eur J Vasc Endovasc Surg，2003，25 (2): 97-109. [3] De Waele JJ，De Laet I，Kirkpatrick AW，et al. Intra-abdominal hypertension and abdominal compartment syndrome[J]. Am J Kidney Dis，2011，5 7(1): 159-169. [4] Kron IL，Harman PK，Nolan SP. The measurement of intraabdminal pressyre as a criterion for abdominal re-exploration[J]. AnnSurg, 1984，1 99(1): 28-30. [5] Malbrain ML，De Laet I，Cheatham M. Consensus conference definitions and recommendations on intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) [J]. Acta Clin Belg Suppl, 2007, 62(1): 44-59. [6] Malbrain ML，Cheatham ML，Kirkpatrick A, et al. results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome.Ⅰ. Definitions[J]. Intensive Care Med，2006，3 2(11): 1722-1732. [7] Al-Bahrani AZ，Darwish A，Hamza N, et al. Gut barrier dysfunction in critically ill surgical patients with abdominal compartment syndrome [J]. Pancreas, 2010，3 9(7): 1064-1069. [8] 孟凡亮，刘枫，胡鹤本. 腹腔间隔室综合征研究进展[J]. 海南 医学，2 011，2 2(21): 122-125. [9] Bertram P，Schachtrupp A，rosch r，et al. Abdominal compartment syndrome[J]. Chirurg，2006, 77(7): 573-574. [10] 齐朝欣，马琼. 膀胱测压法诊断腹腔间隔室综合征10 例[J]. 临床医学，2010，3 0(7): 20-21. [11] Dambrauskas Z，Parseliunas A，Gulbinas A, et al. Early recognition of abdominal compartment syndrome in patients with acute pancreatitis[J]. World J Gastroenterol，2009, 15(6): 717-721. [12] Mao EQ，Tang YQ，Fei J，et al. Fluid therapy for severe acute pancreatitis in acute response stage[J]. Chin Med J (Engl) , 2009, 122(2): 169-173. [13] Malbrain ML. Is it wise not to think about intraabdominal hypertension in the ICU? [J]. Curr Opin Crit Care，2004，10 (2): 132-145. [14] Keskinen P，Leppaniemi A，Pettila V，et al. Intra-abdominal pressure in severe acute pancreatitis[J]. World J Emerg Surg, 2007，2 (1): 2-9. [15] Nast-Kolb D，Bail HJ，Taeger G. Current diagnostics for intraabdominal trauma[J]. Chirurg，2005，7 6(10): 919-926. [16] Siebig S, Iesalnieks I，bruennler T, et al. recovery from respiratory failure after decompression laparotomy for severe acute pancreatitis [J]. World J Gastroenterol，2008，1 4(35): 5467-5470. -
点击查看大图
计量
- 文章访问数: 2720
- HTML全文浏览量: 408
- PDF下载量: 107
- 被引次数: 0
下载:
