McNelis John, Marini Corrado P, Jurkiewicz Antoni, Fields Scott, Caplin Drew, Stein Deborah, Ritter Garry, Nathan Ira, Simms H Hank
Department of Surgery, Northshore-Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, NY, USA.
Arch Surg. 2002 Feb;137(2):133-6. doi: 10.1001/archsurg.137.2.133.
Intraoperative and postoperative variables contribute to the development of abdominal compartment syndrome (ACS) in general surgical patients.
Case-control cohort study of 44 patients admitted to the surgical intensive care unit from March 1, 1995, to January 1, 2001. Groups were matched with respect to age, sex, diagnosis, and procedure. Prospectively collected data included demographics, ventilatory parameters, fluid requirements, hemodynamic and oxygen-derived variables, length of stay, and mortality rates. Statistical analysis was done with the Fisher exact test and/or chi(2) analysis. Continuous variables were analyzed with multivariate and univariate analysis. Data are presented as mean +/- SD. Statistical significance is defined as P<.05.
Long Island Jewish Medical Center (New Hyde Park, NY) is a large tertiary teaching hospital.
Twenty-two patients admitted to the surgical intensive care unit who developed ACS, and 22 case-control patients without ACS.
Identification of variables that predict the development of ACS.
Twenty-two patients with episodes of ACS (group 1) were examined and contrasted with 22 matched patients without ACS (group 2). Using univariate analysis, the groups differed with respect to 24-hour fluid administration and balance, number of emergency procedures, peak airway pressure, central venous pressure, pulmonary artery occlusion pressure, lengths of stay in the hospital and intensive care unit, and mortality rates. With multivariate analysis, only 24-hour fluid balance and peak airway pressure (group 1 vs group 2: mean +/- SD, 15.9 +/- 10.3 L vs 7.0 +/- 3.5 L, and 57.9 +/- 11.9 mm Hg vs 32.2 +/- 7.1 mm Hg, respectively; P<.05) remained significantly different. The groups did not differ with regard to age, cardiac index, operative blood loss, duration of surgery, intraoperative fluid input, or balance. A predictive equation for ACS development was created: P = 1/(1 +e(-z)), where z= -18.6763 + 0.1671 (peak airway pressure) + 0.0009 (fluid balance).
The results of this study indicate that 24-hour fluid balance and peak airway pressure are 2 independent variables predictive of the development of ACS in nontrauma surgical patients.
术中及术后变量会导致普通外科患者发生腹腔间隔室综合征（ACS）。
对1995年3月1日至2001年1月1日入住外科重症监护病房的44例患者进行病例对照队列研究。根据年龄、性别、诊断和手术程序对各组进行匹配。前瞻性收集的数据包括人口统计学资料、通气参数、液体需求量、血流动力学和氧衍生变量、住院时间和死亡率。采用Fisher精确检验和/或卡方分析进行统计分析。连续变量采用多变量和单变量分析。数据以平均值±标准差表示。统计学显著性定义为P<0.05。
长岛犹太医疗中心（纽约州新海德公园）是一家大型三级教学医院。
22例入住外科重症监护病房并发生ACS的患者，以及22例未发生ACS的病例对照患者。
确定预测ACS发生的变量。
对22例发生ACS的患者（第1组）进行检查，并与22例匹配的未发生ACS的患者（第2组）进行对比。采用单变量分析，两组在24小时液体输注量与平衡量、急诊手术数量、气道峰压、中心静脉压、肺动脉闭塞压、住院时间和重症监护病房住院时间以及死亡率方面存在差异。采用多变量分析时，只有24小时液体平衡量和气道峰压（第1组与第2组：平均值±标准差，分别为15.9±10.3L与7.0±3.5L，以及57.9±11.9mmHg与32.2±7.1mmHg；P<0.05）仍存在显著差异。两组在年龄、心脏指数、术中失血量、手术时间、术中液体输入量或平衡量方面无差异。建立了一个ACS发生的预测方程：P = 1/(1 +e(-z))，其中z = -18.6763 + 0.1671（气道峰压）+ 0.0009（液体平衡量）。
本研究结果表明，24小时液体平衡量和气道峰压是预测非创伤性外科患者发生ACS的两个独立变量。
