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分析接受急诊剖腹手术患者的腹内压及手术结果。

Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy.

作者信息

Khan Shehtaj, Verma Akshay Kumar, Ahmad Syed Moied, Ahmad Reyaz

机构信息

Department of Surgery, J. N. Medical College, AMU, Aligarh-202002, Uttar Pradesh, India.

出版信息

J Emerg Trauma Shock. 2010 Oct;3(4):318-25. doi: 10.4103/0974-2700.70747.

DOI:10.4103/0974-2700.70747
PMID:21063552
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2966562/
Abstract

BACKGROUND

Studies have documented the impact of intra-abdominal hypertension (IAH) on virtually every organ. However, it still remains strangely underdiagnosed. The aims of the study were to assess, in patients undergoing emergency laparotomy, whether intra-abdominal pressure (IAP) is an independent predictor of morbidity and mortality, to evaluate the effects of IAH, and to identify hidden cases of abdominal compartment syndrome (ACS).

MATERIALS AND METHODS

The study comprised 197 patients undergoing emergency laparotomy. IAP was measured preoperatively and then postoperatively at 0, 6, and 24 hours. Duration of hospital stay, occurrence of burst abdomen, and mortality were noted as outcomes.

RESULTS

At admission, incidence of IAH was 80%. No significant association was found between IAP and occurrence of burst abdomen (P > 0.1). IAP was found to be a significant predictor of mortality in patients undergoing laparotomy (P < 0.001). Elevated IAP was found to affect all the organ systems adversely. The incidence of post-op ACS was 3.05% in the general population and 13.16% in trauma patients. The mortality rate for this subgroup was 100%.

CONCLUSIONS

IAP is a significant predictor of mortality in patients undergoing laparotomy. IAH has detrimental effects on various organ systems. A more frequent monitoring with prompt decompression may be helpful in decreasing the mortality rate. Further studies are required to establish a screening protocol in patients undergoing laparotomy to detect and manage cases of IAH and ACS.

摘要

背景

研究已证明腹内高压（IAH）几乎对每个器官都有影响。然而，它仍然奇怪地未得到充分诊断。本研究的目的是评估急诊剖腹手术患者的腹内压（IAP）是否是发病率和死亡率的独立预测因素，评估IAH的影响，并识别腹间隔室综合征（ACS）的隐匿病例。

材料与方法

本研究包括197例接受急诊剖腹手术的患者。术前及术后0、6和24小时测量IAP。记录住院时间、切口裂开的发生情况和死亡率作为结果。

结果

入院时，IAH的发生率为80%。未发现IAP与切口裂开的发生之间存在显著关联（P>0.1）。发现IAP是剖腹手术患者死亡率的重要预测因素（P<0.001）。发现IAP升高会对所有器官系统产生不利影响。一般人群中术后ACS的发生率为3.05%，创伤患者中为13.16%。该亚组的死亡率为100%。

结论

IAP是剖腹手术患者死亡率的重要预测因素。IAH对各种器官系统有有害影响。更频繁的监测并及时减压可能有助于降低死亡率。需要进一步研究以建立剖腹手术患者的筛查方案，以检测和处理IAH和ACS病例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8480/2966562/7164f2c26afb/JETS-3-318-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8480/2966562/7d35a04dae0d/JETS-3-318-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8480/2966562/f1eed1be9a2f/JETS-3-318-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8480/2966562/7164f2c26afb/JETS-3-318-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8480/2966562/7d35a04dae0d/JETS-3-318-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8480/2966562/f1eed1be9a2f/JETS-3-318-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8480/2966562/7164f2c26afb/JETS-3-318-g003.jpg

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