外科重症患者合并腹腔间隔室综合征26例诊治分析  

Diagnosis and treatment of abdominal compartment syndrome in critical surgical patients:a report of 26 cases

作　　者：王晓源[1] 杨建青[2] 刘振[2] 潘光栋[2] 吕光宇[1] 韦茵[1] 蔡天斌[1] 

机构地区：[1]广西柳州市人民医院重症医学科,广西柳州545000 [2]广西柳州市人民医院胆胰外科,广西柳州545000

出　　处：《中国普通外科杂志》2012年第6期709-712,共4页China Journal of General Surgery

摘　　要：目的:探讨外科重症合并腹腔间隔室综合征患者诊治。方法:回顾性分析2007年4月—2011年11月26例手术及非手术治疗外科重症合并腹腔间隔室综合征患者的临床资料。分析患者治疗前后腹腔压力变化,及其与腹腔灌注压、尿量、血乳酸浓度、超敏C反应蛋白水平及APACHE II评分相互变化关系;比较两种方法的治疗效果,并分析影响患者预后的因素。结果:手术及非手术治疗均能使患者腹腔压力下降,同时明显改善各项临床理化指标(腹腔灌注压、尿量、血乳酸浓度、超敏C反应蛋白水平及APACHE II)(均P<0.05),手术治疗患者术后腹腔压力下降较非手术治疗腹腔内压力下降更加明显(P=0.011),腹腔内压力,APACHE II评分,超敏C反应蛋白水平是影响患者预后的独立危险因素。结论:外科重症合并腹腔间隔室综合征患者应积极手术干预,炎症反应是影响外科重症合并腹腔间隔室综合征患者预后的重要因素。Objective： To investigate the diagnosis and treatment of abdominal compartment syndrome （ACS） in critical surgical patients. Methods： The clinical data of 26 critical surgical patients with ACS undergoing surgical or non-surgical treatment in our hospital from April 2007 to December 2011 were retrospectively analyzed. The intra- abdominal pressure alteration of the patients before and after treatment and its relations with alterations of abdominal perfusion pressure, urine volume, lactic acid concentration, high-sensitivity C-reactive protein level and APACHE I! score were analyzed. The clinical efficacies of the two treatment modalities were compared, and the prognostic factors of the patients were also determined. Results： The intra-abdominal pressure of the patients decreased by either surgical or non-surgical approaches, meanwhile, the physiochemical indexes （abdominal perfusion pressure, urine volume, lactic acid concentration, high-sensitivity C-reactive protein level and APACHE II score） of the patients were also improved （all P〈0.05）. The intra-abdominal pressure of the patients undergoing surgical treatment reducedmore significantly than that of the patients undergoing non-surgical treatment （P=0.011）. tntra-abdominal pressure level, high-sensitivity C-reactive protein level and APACHE II score were independent risk factors affecting the prognosis of patients Conclusion： Surgical intervention should be performed aggressively to the critical surgical patients with ACS Furthermore, the inflammatory response is an important factor affecting the prognosis of those patients.

关 键 词：腹腔间隔室综合征/外科学 腹腔间隔室综合征/治疗 危重病 

分 类 号：R656.5[医药卫生—外科学]