Abdominal Compartment Syndrome in the Surgical Intensive Care Unit
Abdominal Compartment Syndrome in the Surgical Intensive Care Unit
复制标题
外科重症监护病房的腹腔间隔室综合征
DOI：
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
I. Nathan
中科院分区：
文献类型：
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作者：
J. McNelis;S. Soffer;C. Marini;A. Jurkiewicz;Garry Ritter;H. Simms;I. Nathan
腹腔间隔室综合征（ACS）是一种临床实体后，持续和不受控制的腹腔内高压发展。ACS已被证明影响多个器官系统，包括心血管、呼吸、胃肠道、泌尿生殖系统和神经系统。到目前为止，大多数关于ACS的描述都是在创伤文献中发现的，但是在普通外科人群中ACS的发展正在被越来越多地观察到。在这项研究中，ACS的发展，在非创伤性手术人口进行了描述和检查。回顾性分析了18例外科重症监护室ACS患者的记录。采集的数据包括人口统计学、尿量（mL/h）、心脏指数（L/m2/min）、全身血管阻力指数（mm Hg/L/m2/min）和肺动脉闭塞压、吸气峰压、动脉血氧分压、pH值、二氧化碳分压和腹内压（均以mm Hg为单位）。当它们可用时，在减压之前和之后获得值。数据表示为平均值±标准偏差，并通过学生t检验进行分析;接受显著性对应于P值<0.05。在18例患者中确定了19次ACS发作。平均年龄为69.2岁，观察到的死亡率为61.1%（18人中有11人死亡）。诊断包括腹主动脉瘤（8例）、术后剖腹手术（6例）、胰腺炎（3例）和脑动脉瘤（1例）。在检查的参数中，尿量、吸气峰压和心脏指数在减压前后有显著变化。平均腹内压为43.4 mm Hg。18例患者中有5例（2例腹主动脉瘤，2例术后剖腹手术，1例胰腺炎）在剖腹减压时发现肠坏死。ACS的发展是在外科重症监护病房中描述的。ACS是不受控制的腹内高压的最终结果，并导致全身紊乱。ACS的手术减压显著降低了吸气峰压，同时增加了尿量和心脏指数。观察到的ACS和缺血性肠之间的相关性可能是由于腹腔高压直接导致的粘膜灌注减少。在我们的患者人群中，ACS导致61.1%的死亡率。
The abdominal compartment syndrome (ACS) is a clinical entity that develops after sustained and uncontrolled intra-abdominal hypertension. ACS has been demonstrated to affect multiple organ systems including the cardiovascular, respiratory, gastrointestinal, genitourinary, and neurologic systems. To date most descriptions of ACS are found in the trauma literature, but the development of ACS in the general surgical population is being increasingly observed. In this study the development of ACS in a nontrauma surgical population is described and examined. The records of 18 surgical intensive care unit patients with documented ACS were reviewed retrospectively. Data acquired included demographics, urine output in mL/hour, cardiac index in L/m2/min: systemic vascular resistance index in mm Hg/L/m2/min: and pulmonary artery occlusion pressure, peak inspiratory pressure, partial pressure of oxygen in arterial blood, pH, partial pressure of carbon dioxide, and intra-abdominal pressure (all in mm Hg). When they were available values were obtained before and after decompression. Data are presented as mean ± standard deviation and are analyzed by Student's t-test; significance was accepted to correspond to a P value <0.05. Nineteen episodes of ACS were identified in 18 patients. The average age was 69.2 years, and the observed mortality of the group was 61.1 per cent (11 of 18). Diagnoses included abdominal aortic aneurysm (eight), postoperative laparotomy (six), pancreatitis (three), and cerebral aneurysm (one). Of the parameters examined urine output, peak inspiratory pressure, and cardiac index demonstrated a significant change before and after decompression. The average intra-abdominal pressure was 43.4 mm Hg. Five of 18 patients (two with abdominal aortic aneurysm, two with postoperative laparotomy, and one with pancreatitis) were found to have necrotic bowel on decompressive laparotomy. The development of ACS is described in a surgical intensive care unit. ACS is the end result of uncontrolled intra-abdominal hypertension and results in systemic derangements. Surgical decompression of ACS significantly reduces peak inspiratory pressure while increasing urine output and cardiac index. The observed association between ACS and ischemic bowel may result from decreased mucosal perfusion as a direct result of abdominal hypertension. In our patient population ACS resulted in a 61.1 per cent mortality.
影响因子：
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作者：
BARNES, GE;LAINE, GA;GRANGER, HJ
通讯作者：
GRANGER, HJ