Muntean V, Galasiu R, Fabian O
Clinica IV Chirurgie UMF Cluj, Spitalul Universitar CF Cluj, Str. Republicii 18, 3400 Cluj-Napoca.
Chirurgia (Bucur). 2002 Sep-Oct;97(5):447-57.
The acute intra-abdominal hypertension causes profound physiologic abnormalities, both within and outside the abdomen. Just as in compartment syndrome in the extremities, gut mucosal ischemia begins long before clinical signs are evident, explaining the name of "abdominal compartment syndrome" given to the acute, markedly increased intra-abdominal pressure. The abdominal compartment syndrome was initially described in patients with severe abdominal injuries and massive transfusions and crystalloid infusions, caused by the closure of fascia or skin under tension, the use of bulky abdominal packs to control diffuse bleeding, the massive bowel distension and edema, and the continued bleeding into the abdominal cavity. Intra-abdominal pressure can be monitored by measuring the urinary bladder pressure with a manometer, connected to the transurethral Foley catheter, with the symphysis pubis as the zero point. A persistent elevation of the intra-abdominal pressure beyond 20-25 cmH2O, with significant respiratory, hemodynamic and renal dysfunction is an indication for abdominal decompression, before the manifestations of abdominal compartment syndrome became clinically evident. The mortality in patients with abdominal compartment syndrome is over 40%, even when adequately treated.
急性腹腔内高压会导致腹部内外出现严重的生理异常。就如同肢体的骨筋膜室综合征一样，早在临床症状出现之前，肠道黏膜就已发生缺血，这也解释了为何将急性、明显升高的腹腔内压力称为“腹腔间隔室综合征”。腹腔间隔室综合征最初在严重腹部损伤、大量输血和输注晶体液的患者中被描述，其病因包括在张力下关闭筋膜或皮肤、使用大量腹部敷料控制弥漫性出血、大量肠扩张和水肿以及持续腹腔内出血。腹腔内压力可通过连接经尿道Foley导管的压力计测量膀胱压力来监测，以耻骨联合为零点。在腹腔间隔室综合征的临床表现变得明显之前，腹腔内压力持续超过20 - 25 cmH₂O，并伴有明显的呼吸、血流动力学和肾功能障碍，是进行腹腔减压的指征。即使得到充分治疗，腹腔间隔室综合征患者的死亡率仍超过40%。
