Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
J Zhejiang Univ Sci B. 2011 Feb;12(2):156-62. doi: 10.1631/jzus.B1000185.
This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units (ICUs). A total of 108 (76.6%) questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission, ICU length of stay, acute physiology and chronic health evaluation (APACHE) II score, and mortality were 18.2 beds, 764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure (IAP). Although the vast majority of the ICUs adopted the exclusively transvesicular method, the overwhelming majority (88.0%) only measured IAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for IAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended abdomen (92%), worsening oliguria (80%), and increased ventilatory support requirement (68%). Common causes for IAH/ACS were "third-spacing from massive volume resuscitation in different settings" (88%), "intra-abdominal bleeding", and "liver failure with ascites" (52% for both). Though 60% respondents would recommend surgical decompression when the IAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of respondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physicians in China to help to establish clear diagnostic criteria and appropriate management for these common, but life-threatening, diseases.
这项调查旨在阐明中国三级医院重症监护医师对腹腔内高压（IAH）/腹腔间隔室综合征（ACS）的当前认识和临床处理。我们向 141 名不同重症监护病房（ICU）的医师邮寄了一份包含 20 个问题的问卷。共收回 108 份（76.6%）。其中，四分之三的人在综合内科-外科 ICU 工作，近 80%的人接受过内科或急诊医学的初级培训。平均 ICU 床位数、年入院人数、ICU 住院时间、急性生理学和慢性健康评估（APACHE）II 评分和死亡率分别为 18.2 张、764.5 例、8.3 天、19.4 分和 21.1%。在回答问题的人中，30.6%的人从未测量过腹腔内压（IAP）。尽管绝大多数 ICU 采用了单纯经膀胱的方法，但绝大多数（88.0%）仅在临床怀疑 IAH/ACS 时测量 IAP，只有 29.3%的人经常或常规测量 IAP。此外，84.0%的人使用了错误的预充盐水量，而 88.0%的人在与世界腹部分隔综合征协会推荐的 IAP 监测标准不一致的参考点进行零位校正。ACS 主要怀疑是由于腹部膨隆（92%）、少尿恶化（80%）和通气支持需求增加（68%）。IAH/ACS 的常见原因是“不同情况下大量容量复苏导致第三间隙”（88%）、“腹腔内出血”和“肝衰竭伴腹水”（各占 52%）。尽管 60%的受访者会建议在 IAP 超过 25mmHg 时进行手术减压，同时伴有器官功能障碍的迹象，但近四分之三的受访者更喜欢利尿和透析。共有 68%的受访者会建议在 ACS 的治疗中进行腹腔穿刺。总之，中国大多数重症监护医师绝对需要紧急的系统教育，以帮助建立这些常见但危及生命的疾病的明确诊断标准和适当的治疗方法。
