Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation
Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation
复制标题
DOI：
10.1016/s0002-9610(02)01050-4
复制
发表时间：
2002-12-01
影响因子：
3
通讯作者：
Moore, FA
中科院分区：
文献类型：
--
作者：
Balogh, Z;McKinley, BA;Moore, FA
背景：继发性腹腔间隔室综合征 (ACS) 一词已用于描述发生 ACS 但没有腹部损伤的创伤患者。本研究的目的是描述在标准化休克复苏过程中发生继发性 ACS 的主要创伤受害者。方法：回顾我们的标准化休克复苏前瞻性数据库，以获得继发性 ACS 患者腹部减压休克前后的相关数据。进行重点图表审查以确认与时间相关的结果。结果：在截至 2001 年 5 月的 30 个月期间，128 名标准化休克复苏患者中有 11 名 (9%) 发展为继发性 ACS。所有患者均出现严重休克（收缩压 85 ± 5 mm Hg，碱赤字 8.6 +/- 1.6 mEq/L），严重损伤（损伤严重程度评分 28 +/- 3），需要积极休克复苏（24 小时内 26 +/- 2 单位血液，38 +/- 3 L 晶体）。所有继发性 ACS 病例均在入院 24 小时内得到识别并减压。减压后，膀胱压力和全身血管阻力下降，而平均动脉压、心脏指数和静态肺顺应性上升。死亡率为54%。那些死亡的患者未能对心脏指数增加的减压做出反应，也无法维持降低的膀胱压力。结论：继发性 ACS 是一种早期并发症，如果监测得当，对于需要积极复苏的严重非腹部创伤患者来说是一种可识别的并发症。 (C) 2002 Excerpta Medica Inc. 保留所有权利。
Background: The term secondary abdominal compartment syndrome (ACS) has been applied to describe trauma patients who develop ACS but do not have abdominal injuries. The purpose of this study was to describe major trauma victims who developed secondary ACS during standardized shock resuscitation.Methods: Our prospective database for standardized shock resuscitation was reviewed to obtain before and after abdominal decompression shock related data for secondary ACS patients. Focused chart review was done to confirm time-related outcomes.Results: Over the 30 months period ending May 2001, 11 (9%) of 128 standardized shock resuscitation patients developed secondary ACS. All presented in severe shock (systolic blood pressure 85 5 mm Hg, base deficit 8.6 +/- 1.6 mEq/L), with severe injuries (injury severity score 28 +/- 3) and required aggressive shock resuscitation (26 +/- 2 units of blood, 38 +/- 3 L crystalloid within 24 hours). All cases of secondary ACS were recognized and decompressed within 24 hours of hospital admission. After decompression, the bladder pressure and the systemic vascular resistance decreased, while the mean arterial pressure, cardiac index, and static lung compliance increased. The mortality rate was 54%. Those who died failed to respond to decompression with increased cardiac index and did not maintain decreased bladder pressure.Conclusions: Secondary ACS is an early but, if appropriately monitored, recognizable complication in patients with major nonabdominal trauma who require aggressive resuscitation. (C) 2002 Excerpta Medica Inc. All rights reserved.