Biffl W L, Moore E E, Burch J M, Offner P J, Franciose R J, Johnson J L
Department of Surgery, Box 0206, Denver Health Medical Center, 777 Bannock St., Denver, CO 80204-4507, USA.
Am J Surg. 2001 Dec;182(6):645-8. doi: 10.1016/s0002-9610(01)00814-5.
Recent reports have described resuscitation-induced, "secondary" abdominal compartment syndrome (ACS) in trauma patients without intra-abdominal injuries. We have diagnosed secondary ACS in a variety of nontrauma as well as trauma patients. The purpose of this review is to characterize patients who develop secondary ACS.
Our prospective ACS database was reviewed for cases of secondary ACS. Physiologic parameters and outcomes were recorded. Data are expressed as mean +/- SEM.
Fourteen patients (13 male, aged 45 +/- 5 years) developed ACS 11.6 +/- 2.2 hours following resuscitation from shock. Eleven (79%) had required vasopressors; the worst base deficit was 14.1 +/- 1.9. Resuscitation included 16.7 +/- 3.0 L crystalloid and 13.3 +/- 2.9 red blood cell units. Decompressive laparotomy improved intra-abdominal, systolic, and peak airway pressures, as well as urine output; however, mortality was 38% among trauma and 100% among nontrauma patients.
Secondary ACS may be encountered by general surgeons in a variety of clinical scenarios; resuscitation from severe shock appears to be the critical factor. Early identification and abdominal decompression are essential. Unfortunately, in our experience, this is a highly lethal event.
近期报告描述了在无腹腔内损伤的创伤患者中复苏诱导的“继发性”腹腔间隔室综合征（ACS）。我们在各种非创伤性以及创伤性患者中诊断出继发性ACS。本综述的目的是描述发生继发性ACS的患者特征。
我们对前瞻性ACS数据库中继发性ACS的病例进行了回顾。记录生理参数和结局。数据以平均值±标准误表示。
14例患者（13例男性，年龄45±5岁）在休克复苏后11.6±2.2小时发生ACS。11例（79%）需要血管升压药；最严重的碱缺失为14.1±1.9。复苏包括16.7±3.0L晶体液和13.3±2.9个红细胞单位。减压剖腹术改善了腹腔内压、收缩压和气道峰压以及尿量；然而，创伤患者的死亡率为38%，非创伤患者的死亡率为100%。
普通外科医生可能在各种临床情况下遇到继发性ACS；严重休克复苏似乎是关键因素。早期识别和腹部减压至关重要。不幸的是，根据我们的经验，这是一个致死率很高的事件。
