Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma
Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma
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DOI：
10.1001/archsurg.136.6.676
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发表时间：
2001-06-01
影响因子：
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通讯作者：
Burch, JM
中科院分区：
文献类型：
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作者：
Offner, PJ;de Souza, AL;Burch, JM
假设：腹腔间隔室综合征（ACS）是损伤控制性剖腹手术的一种病态并发症。此外，腹部闭合技术影响ACS的发生率。设计：回顾性队列研究。设置：城市一级创伤中心。患者：我们研究了52例创伤患者，他们在截至1999年12月31日的5年内需要损伤控制剖腹术，并且存活超过48小时。主要结果测量：结果：平均（+/- SD）年龄为33+/-2岁; 38例（73%）为男性。29名患者（56%）的损伤机制为钝性，平均（+/-：SD）损伤严重度评分为28 +/- 2。23例患者（44%）发生了ARDS和/或MOF; ARDS和MOF使死亡率从12%（3/26）增加到42%（11/26）。腹腔间隔室综合征是一种常见并发症（17/52），与ARDS和/或MOF（12例患者[71%] vs 11例无ACS患者[31%]; P= 0.02，卡方检验）和死亡（6例患者[35%] vs 8例无ACS患者[23%]）增加相关。Primary.首次剖腹手术时筋膜闭合（n=10）与8例（80%）ACS相关（P= 0.001，卡方检验）和9例（90%）ARDS和/或MOF（P= 0.01，卡方检验）;皮肤闭合（n=25），其中ACS 6例（24%），ARDS/MOF 9例（36%）; Bogota囊闭合术17例，其中ACS 3例（18%），ARDS/MOF 8例（47%）。特别是，ACS是增加ARDS和/或MOF和死亡率的严重并发症。在初次剖腹手术时避免一期筋膜缝合可将ACS的风险降至最低。
Hypothesis: Abdominal compartment syndrome (ACS) is a morbid complication of damage-control laparotomy. Moreover, the technique of abdominal closure influences the frequency of ACS.Design: Retrospective cohort study.Setting: Urban level I trauma center.Patients: We studied 52 patients with trauma who required damage-control laparotomy during the 5 years ending December 31, 1999, and who survived longer than 48 hours.Main Outcome Measures: Abdominal compartment syndrome, acute respiratory distress syndrome (ARDS), and multiple organ failure (MOF).Results: Mean (+/- SD) age was 33+/-2 years; 38 (73%) were male. Mechanism of injury was blunt in 29 patients (56%), and mean (+/-: SD) Injury Severity Score was 28 +/- 2. Development of ARDS and/or MOF was seen in 23 patients (44%); ARDS and MOF increased mortality from 12% (3/26) to 42% (11/26). Abdominal compartment syndrome was a common complication (17/52), and was associated with an increase in ARDS and/or MOF (12 patients [71%] vs 11 patients [31%] without ACS; P=.02, chi (2) test) and death (6 [35%] vs 8 patients [23%] without ACS). Primary. fascial closure (n=10) at the initial laparotomy was associated with ACS in 8 (80%) (P=.001, chi (2) test) and ARDS and/or MOF in 9 (90%) (P=.01, chi (2) test); skin closure (n=25), with ACS in 6 (24%) and ARDS/MOF in 9 (36%); and Bogota bag closure (n=17), with ACS in 3 (18%) and ARDS/MOF in 8 (47%).Conclusions: Damage-control laparotomy is associated with frequent complications. In particular, ACS is a serious complication that increases ARDS and/or MOF and mortality. Avoiding primary fascial closure at the initial laparotomy can minimize the risk for ACS.