Lam M C W, Yang P T, Skippen P W, Kissoon N, Skarsgard E D
Department of Surgery (Pediatric Surgery), British Columbia Children's Hospital, Vancouver, Canada.
Anaesth Intensive Care. 2008 Sep;36(5):726-31. doi: 10.1177/0310057X0803600517.
We report three paediatric cases, and summarise the reported experience in two others, with cardiorespiratory failure requiring extracorporeal life support for which supportive pump flows could not be maintained due to abdominal compartment syndrome. In two of our patients, the mechanism of abdominal compartment syndrome was massive intra-abdominal fluid extravasation secondary to sepsis, while in the third, the mechanism was post-traumatic intra-abdominal haemorrhage. Although all three children eventually died, decompressive laparotomy and arrest of haemorrhage in the trauma patient restored venous return and enabled technically adequate extracorporeal life support. In two previously reported cases of sepsis with massive fluid resuscitation resulting in abdominal compartment syndrome, one patient died without attempted decompression, while the other patient survived after peritoneal catheter placement restored venous return. Once correctable causes of inadequate venous cannula drainage have been excluded, abdominal compartment syndrome should be considered in any patient on extracorporeal life support with a taut abdomen and reduced venous return. If abdominal compartment syndrome can be proven or is strongly suspected, there may be a role for selective decompressive laparotomy.
我们报告了3例儿科病例，并总结了另外2例的报道经验，这些病例均因腹腔间隔室综合征导致无法维持支持性泵流量而需要体外生命支持的心肺衰竭。在我们的2例患者中，腹腔间隔室综合征的机制是脓毒症继发的大量腹腔内液体外渗，而第3例的机制是创伤后腹腔内出血。尽管所有3名儿童最终均死亡，但创伤患者的剖腹减压术和出血控制恢复了静脉回流，并使体外生命支持在技术上得以充分实施。在之前报道的2例因大量液体复苏导致腹腔间隔室综合征的脓毒症病例中，1例患者未尝试减压即死亡，而另1例患者在置入腹膜导管恢复静脉回流后存活。一旦排除了静脉插管引流不足的可纠正原因，对于任何接受体外生命支持且腹部紧绷、静脉回流减少的患者，都应考虑腹腔间隔室综合征。如果腹腔间隔室综合征能够得到证实或高度怀疑，则选择性剖腹减压术可能会发挥作用。
