腹腔扩容术防治创伤后腹腔间隙综合征  

Intra-abdominal volume increment for preventing and treating abdominal compartment syndrome following trauma

作　　者：孙士锦[1] 李陈成[1] 李英才[1] 王韬[1] 谭浩[1] 姚元章[1] 张连阳[1] 

机构地区：[1]第三军医大学第三附属医院野战外科研究所,创伤,烧伤与复合伤国家重点实验室,全军战创伤中心,重庆400042

出　　处：《创伤外科杂志》2013年第3期240-243,共4页Journal of Traumatic Surgery

基　　金：国家科技支撑计划"创伤救治新技术研究及集成示范"(2012BAI11B01);全军十二五项目(BW812J033)

摘　　要：目的探讨腹腔扩容术防治创伤后腹腔间隙综合征的效果。方法回顾性分析了2007年11月～2012年3月我院创伤中心收治的22例严重创伤患者(腹内高压6例、腹腔间隙综合征16例)的临床资料和腹腔扩容术的治疗结果。所有患者均接受腹腔扩容术治疗,首先探查全腹腔,控制活动性出血及感染源等;然后将大网膜平铺于切口下方,根据切口大小将2～3块Vacuseal材料置于大网膜表面,四周与前鞘、白线或皮肤缝合,引流管维持60～80mmHg的持续负压,7～14d后通过Ⅱ期缝合行确定性腹壁重建。结果本组22例救治成功16例(成功率72.73%);死亡6例(27.27%),4例死于多器官功能衰竭(MODS),1例死于严重颅脑损伤所致脑疝,1例吸毒、结肠脾曲刀刺伤术后转入患者放弃治疗。22例手术患者手术前后膀胱压值间差别有统计学意义(P<0.01)。结论腹腔扩容术不仅保护腹腔内容物,便于再次探查手术,更利于清除腹腔积液并计量,减轻腹腔组织水肿,控制感染,逆转组织水肿并帮助皮肤和筋膜靠拢,利于后期关闭筋膜和腹壁,对于防治创伤后腹腔间隙综合征(ACS)的效果显著,值得临床广泛应用。Objective To discuss the effect of intra-abdominal volume increment（IAVI） in preventing and treating abdominal compartment syndrome （ ACS ） following trauma. Methods Data of 22 patients were retrospec- tively analyzed,including 6 cases of intra-abdominal hypertension（IAH） and 16 cases of ACS, who were admitted into our hospital from Nov. 2007 to Mar. 2012. All patients received intra - abdominal volume increment. The steps were as follow. Firstly, laparotomy was performed, active bleeding and source of infection were controlled. Then greater omentum was put under the incision,the Vacuseal dressings were applied on the greater omentum, and the circumference was sutured with protheca, linea alba or skin. Continuous negative pressure was maintained 60- 80mmHg using the drainage tube, and the definitive abdominal wall reconstruction was conducted by secondary su- ture. Results Successful treatment was achieved in 16 patients, death in 6 patients. The death cases included 4 cases of MODS, 1 case of cerebral hernia and 1 case of refusing any treatment. There was significant difference in vesical pressure. Conclusion IAVI has advantages of protecting abdominal organ, being beneficial for performing second laparotomy and cleaning and counting seroperitoneum, mitigating swelling of abdominal tissue, controlling in- fection and reversing tissue swelling. The IAVI also helps to close the skin and fascia, which is beneficial for closing fascia and abdominal wall in the later stage. It has remarkable effect on preventing and treating abdominal compart- ment syndrome （ACS） ,and therefore it is suitable for more extensive application in clinic.

关 键 词：腹腔间隙综合征 腹腔扩容术 创伤 负压封闭技术 减压 

分 类 号：R656[医药卫生—外科学]