Secondary abdominal compartment syndrome after severe extremity injury: Are early, aggressive fluid resuscitation strategies to blame?
Secondary abdominal compartment syndrome after severe extremity injury: Are early, aggressive fluid resuscitation strategies to blame?
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DOI：
10.1097/ta.0b013e3181622bb6
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发表时间：
2008-02-01
影响因子：
--
通讯作者：
Cotton, Bryan A.
中科院分区：
文献类型：
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作者：
Madigan, Michael C.;Kemp, Clinton D.;Cotton, Bryan A.
简介：继发性腹腔间隔室综合征（ACS）是在没有腹部损伤的情况下发生的ACS。一些作者认为继发性ACS的发生是严重休克治疗中经常采用的积极晶体复苏的不可避免的后遗症。我们假设不良的复苏技术，包括早期和过量的晶体液给药，使肢体损伤患者有发生继发性ACS的风险。方法：查询美国外科医师学会创伤登记数据库，查找1月1日至2010年1月30日期间在我们机构治疗的四肢简明损伤量表（AIS）评分为3分或更高且腹部AIS评分为0分的所有患者，2001年和2005年12月31日。研究组包括那些发展为继发性ACS的患者，而对照组包括那些没有发展为继发性ACS的患者。结果：48例患者发展为继发性ACS，并与48例随机选择的患者进行了比较，这些患者的四肢AIS评分为3分或更高，腹部AIS评分为0分。两组在年龄、性别、种族或个体AIS评分方面无差异。然而，继发性ACS组的损伤严重程度评分略高（25.6 vs. 21.4，p=0.02），手术室晶体液给药显著更高（9.9 L vs. 2.7 L，p < 0.001），快速输注器使用频率更高（12.5% vs. 0.0%，p=0.01）。多元Logistic回归分析确定院前和急诊科晶体作为继发性ACS的预测因子。结论：积极的复苏技术，往往开始在院前设置，出现严重的肢体损伤发展为继发性ACS的患者的可能性增加。早期大量晶体液给药是继发性ACS的最大预测因素。
Introduction: Secondary abdominal compartment syndrome (ACS) is the development of ACS in the absence of abdominal injury. The development of secondary ACS has been viewed by some authors as an unavoidable sequela of the aggressive crystalloid resuscitation often employed in the treatment of severe shock. We hypothesized that poor resuscitation techniques, including early and excessive crystalloid administration, places patients with extremity injuries at risk for developing secondary ACS.Methods: The Trauma Registry of the American College of Surgeons database was queried for all patients with an extremity Abbreviated Injury Scale (AIS) score of 3 or greater and abdominal AIS score of 0 treated at our institution between January 1, 2001 and December 31, 2005. The study group included those patients who developed secondary ACS, whereas the comparison cohort included those who did not develop secondary ACS.Results: Forty-eight patients developed secondary ACS and were compared with 48 randomly selected patients who had an extremity AIS score of 3 or greater and an abdomen AIS score of 0. There were no differences between the groups with respect to age, sex, race, or individual AIS scores. However, the secondary ACS group had a slightly higher Injury Severity Score (25.6 vs. 21.4, p=0.02), significantly higher operating room crystalloid administration (9.9 L vs. 2.7 L, p < 0.001), and more frequent use of a rapid infuser (12.5% vs. 0.0%, p=0.01). Multiple logistic regression identified prehospital and emergency department crystalloid as predictors of secondary ACS.Conclusions: Aggressive resuscitation techniques, often begun in the prehospital setting, appear to increase the likelihood of patients with severe extremity injuries developing secondary ACS. Early, large volume crystalloid administration was the greatest predictor of secondary ACS.