Daliakopoulos Stavros I, Schaedel Manja, Klimatsidas Michael N, Spiliopoulos Sotirios, Koerfer Reiner, Tenderich Gero
Herzzentrum Essen, Herwarthstrasse 100, 45138 Essen, Germany.
J Cardiothorac Surg. 2010 Nov 10;5:108. doi: 10.1186/1749-8090-5-108.
Elevated intra-abdominal pressure (IAP) has been identified as a cascade of pathophysiologic changes leading in end-organ failure due to decreasing compliance of the abdomen and the development of abdomen compartment syndrome (ACS). Spontaneous retroperitoneal hematoma (SRH) is a rare clinical entity seen almost exclusively in association with anticoagulation states, coagulopathies and hemodialysis; that may cause ACS among patients in the intensive care unit (ICU) and if treated inappropriately represents a high mortality rate.
We report four patients (a 36-year-old Caucasian female, a 59-year-old White-Asian male, a 64-year-old Caucasian female and a 61-year-old Caucasian female) that developed an intra-abdominal hypertension due to heparin-induced retroperitoneal hematomas after implantation of ventricular assist devices because of heart failure. Three of the patients presented with dyspnea at rest, fatigue, pleura effusions in chest XR and increased heart rate although b-blocker therapy. A 36-year old female (the forth patient) presented with sudden, severe shortness of breath at rest, 10 days after an "acute bronchitis". At the time of the event in all cases international normalized ratio (INR) was <3.5 and partial thromboplastin time <65 sec. The patients were treated surgically, the large hematomas were evacuated and the systemic manifestations of the syndrome were reversed.
Identifying patients in the ICU at risk for developing ACS with constant surveillance can lead to prevention. ACS is the natural progression of pressure-induced end-organ changes and develops if IAP is not recognized and treated in a timely manner. Failure to recognize and appropriately treat ACS is fatal while timely intervention - if indicated - is associated with improvements in organ function and patient survival. Means for surgical decision making are based on clinical indicators of adverse physiology, rather than on a single measured parameter.
腹腔内压力（IAP）升高已被确认为一系列病理生理变化，由于腹部顺应性降低和腹腔间隔室综合征（ACS）的发展，最终导致器官功能衰竭。自发性腹膜后血肿（SRH）是一种罕见的临床病症，几乎仅见于抗凝状态、凝血障碍和血液透析患者；它可能导致重症监护病房（ICU）患者发生ACS，若治疗不当则死亡率很高。
我们报告了4例患者（1名36岁的白种女性、1名59岁的白种与亚洲混血男性、1名64岁的白种女性和1名61岁的白种女性），他们因心力衰竭植入心室辅助装置后，因肝素诱导的腹膜后血肿而出现腹腔内高压。3例患者表现为静息时呼吸困难、疲劳、胸部X线显示胸腔积液以及尽管接受了β受体阻滞剂治疗但心率仍加快。1名（第4例）36岁女性在“急性支气管炎”10天后出现突发、严重的静息时呼吸急促。在所有病例发生该事件时，国际标准化比值（INR）<3.5，部分凝血活酶时间<65秒。这些患者接受了手术治疗，清除了大血肿，综合征的全身表现得到逆转。
通过持续监测识别ICU中有发生ACS风险的患者可实现预防。ACS是压力诱导的器官变化的自然进展，如果IAP未得到及时识别和治疗就会发生。未能识别和适当治疗ACS是致命的，而及时干预（如果有指征）与器官功能改善和患者生存相关。手术决策的依据是不良生理学的临床指标，而非单一测量参数。
