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开放性腹部的处理

Managing the open abdomen.

作者信息

Kaplan Mark

机构信息

Trauma and Surgical Critical Care, Albert Einstein Medical Center, Philadelphia, PA, USA.

出版信息

Ostomy Wound Manage. 2004 Jan;50(1A Suppl):C2, 1-8, quiz 1p following 8.

Abstract

Control of intra-abdominal fluid secretion, facilitation of abdominal exploration, and preservation of the fascia for abdominal wall closure is a major challenge in the management of patients with an open abdomen. Studies comparing different protocols of care have not been conducted and frequency of exploration, surgical procedures, and indications for definitive closure are generally based on clinical judgment. Morbidity and mortality rates are high. Vacuum-assisted therapy has been reported to help meet the challenges of managing the open abdomen and is particularly useful in patients with abdominal compartment syndromes, traumatic injuries, and severe intra-abdominal sepsis. Over the years, clinicians have developed various approaches to achieve vacuum-assisted closure using wall suction. Some disadvantages of the wall-suction methods are eliminated when using more recently developed vacuum therapy devices. These devices apply subatmospheric pressure, reducing bowel edema, bacterial counts, and inflammatory substances found in open abdominal wounds while eliminating the need for frequent dressing changes, maintaining intact skin, and improving fluid management. The results of six case studies presented are encouraging, suggesting that this treatment approach is safe and effective. Controlled clinical studies to establish the safety and effectiveness of this treatment approach and to facilitate the development of treatment guidelines are needed to help manage an increasingly common group of patients who might benefit from this treatment approach.

摘要

控制腹腔内液体分泌、便于进行腹部探查以及保留用于腹壁闭合的筋膜,是开放性腹部患者管理中的一项重大挑战。尚未开展比较不同护理方案的研究,探查频率、手术操作以及确定性闭合的指征通常基于临床判断。发病率和死亡率很高。据报道,负压辅助治疗有助于应对开放性腹部管理的挑战,尤其适用于患有腹腔间隔室综合征、创伤性损伤和严重腹腔内脓毒症的患者。多年来,临床医生已开发出各种利用壁式吸引实现负压辅助闭合的方法。使用最近开发的负压治疗设备时,壁式吸引方法的一些缺点得以消除。这些设备施加负压,减轻肠水肿、细菌数量以及开放性腹部伤口中发现的炎性物质,同时无需频繁更换敷料,保持皮肤完整,并改善液体管理。所呈现的六个病例研究结果令人鼓舞,表明这种治疗方法安全有效。需要进行对照临床研究,以确定这种治疗方法的安全性和有效性,并促进治疗指南的制定,从而帮助管理可能受益于这种治疗方法的日益常见的患者群体。

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