O'Mara Michael S, Papasavas Pavlos K, Newton E Douglas, Caushaj Philip F
The Western Pennsylvania Hospital, Temple University School of Medicine Clinical Campus, Pittsburgh, Pa. 15224, USA.
Plast Reconstr Surg. 2004 Dec;114(7):1842-5. doi: 10.1097/01.prs.0000143581.16449.39.
Standard therapy for abdominal compartment syndrome is laparotomy. In many patients, laparotomy involves a recent incision; for others, volume of resuscitation may be the cause. The components separation technique allows difficult abdominal closure. The authors studied the effect of a modified separation of parts on abdominal compartment syndrome in an animal model. Eight pigs were instrumented for measurement of central venous pressure, mean arterial pressure, peak airway pressure, and intraabdominal pressure. Intraabdominal hypertension to 25 mmHg was established with intraperitoneal fluid infusion. Modified separation of parts was performed by sequential release of the abdominal wall layers. With increased intraabdominal pressure, mean arterial pressure (55.3 +/- 12.0 to 65.3 +/- 11.0), central venous pressure (7.7 +/- 2.4 to 13.3 +/- 6.9), and peak airway pressure (20.2 +/- 2.4 to 25.3 +/- 4.1; p < 0.05) also increased. Maximum intraabdominal pressure was 26.0 +/- 1.2 mmHg. Skin incision resulted in a decrease in intraabdominal pressure to 21.7 +/- 4.5, external oblique release to 18.3 +/- 3.9, internal oblique release to 13.2 +/- 4.0, and transversus muscle incision to 7.0 +/- 2.5 mmHg (p < 0.05). With completion of components separation, mean arterial pressure remained increased (63.2 +/- 16.9), central venous pressure decreased (6.8 +/- 3.6; p < 0.05), and peak airway pressure decreased (22.7 +/- 3.9; p < 0.05). Modified separation of parts technique effectively releases intraabdominal hypertension and reverses the physiologic derangements associated with abdominal compartment syndrome in the animal model.
腹腔间隔室综合征的标准治疗方法是剖腹手术。在许多患者中，剖腹手术涉及近期的切口；对其他患者而言，复苏液体量可能是病因。成分分离技术有助于困难的腹壁关闭。作者在动物模型中研究了改良的部分分离对腹腔间隔室综合征的影响。八只猪被植入监测中心静脉压、平均动脉压、气道峰压和腹腔内压的装置。通过腹腔内输注液体使腹腔内高压达到25 mmHg。改良的部分分离通过依次松开腹壁各层来进行。随着腹腔内压升高，平均动脉压（从55.3±12.0升高至65.3±11.0）、中心静脉压（从7.7±2.4升高至13.3±6.9）和气道峰压（从20.2±2.4升高至25.3±4.1；p<0.05）也升高。腹腔内最高压力为26.0±1.2 mmHg。皮肤切开使腹腔内压降至21.7±4.5，腹外斜肌松解后降至18.3±3.9，腹内斜肌松解后降至13.2±4.0，腹横肌切开后降至7.0±2.5 mmHg（p<0.05）。完成成分分离后，平均动脉压仍升高（63.2±16.9），中心静脉压降低（6.8±3.6；p<0.05），气道峰压降低（22.7±3.9；p<0.05）。改良的部分分离技术可有效缓解动物模型中的腹腔内高压，并逆转与腹腔间隔室综合征相关的生理紊乱。
