Costa Sílvia, Gomes Aline, Graça Susana, Ferreira António, Fernandes Gonçalo, Esteves Joana, Costa Alexandre, Fernandes Paula, Castelões Paula, Maciel Jorge
Serviço de Cirurgia, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 2:131-6. Epub 2011 Dec 31.
The Abdominal Compartment Syndrome (ACS) is a clinical entity recognized for over a century, but only recently its risk criteria, monitorization and treatment have been defined by the World Society of the Abdominal Compartment Syndrome (WSACS). The general surgeon's involvement is vital since this syndrome is common in surgical patients and because its treatment may culminate in a laparostomy. 250 questionnaires of 17 questions were distributed among general surgeons attending the XXVIII Portuguese Congress of Surgery. The data were analyzed using SPSS® v16. We received 36,4% (91) of the delivered questionnaires, most of which from male surgeons (63,7%), from central hospitals (75,8%), working 42 h per week (70.3%), whose average of age was 38 years. About half of the respondents received training in Intensive Care Units. All surgeons had already heard about measuring the Intra- abdominal Pressure (IAP), which was being performed at 89% of their hospitals. About 40% of surgeons only admitted intra-abdominal hypertension above 20 mmHg (only 22% indicated the correct value of 12 mmHg). 36,3% of surgeons suggested that a decompressive laparostomy must be carried out for primary ACS if IAP greater then 20 mmHg with new organ failure; 36.3% favoured the "Vacuum-pack"-like system, and 56% only re-operate the patients "as needed". 48,4% of surgeons had already performed decompressive laparostomy, 66% of which had residence training in a ICU (p = 0,005). Respondents also pointed an average mortality related to ACS of 81% without laparostomy, and a reduction to 38,5% after performing that procedure. Only 26% of the surgeons were aware of the WSACS consensus definitions and recommendations, of those, 83% had already performed a laparostomy (P<0,001). It can be concluded that, in spite of recognizing the ACS as a clinical entity, portuguese general surgeons are quite unaware of the WSACS definitions and treatment guidelines, urging the need for its divulgation.
腹腔间隔室综合征(ACS)是一个已被认可了一个多世纪的临床实体,但直到最近,其风险标准、监测和治疗才由世界腹腔间隔室综合征协会(WSACS)进行了定义。普通外科医生的参与至关重要,因为这种综合征在外科患者中很常见,而且其治疗可能最终需要进行剖腹术。我们向参加第28届葡萄牙外科学会的普通外科医生发放了250份包含17个问题的问卷。使用SPSS® v16对数据进行分析。我们收到了所发放问卷的36.4%(91份),其中大部分来自男性外科医生(63.7%),来自中心医院(75.8%),每周工作42小时(70.3%),平均年龄为38岁。约一半的受访者曾在重症监护病房接受培训。所有外科医生都听说过测量腹腔内压力(IAP),其所在医院有89%正在进行此项测量。约40%的外科医生仅认可腹腔内高压超过20 mmHg(只有22%指出正确值为12 mmHg)。36.3%的外科医生建议,如果IAP大于20 mmHg且出现新的器官功能衰竭,对于原发性ACS必须进行减压剖腹术;36.3%倾向于“真空包装”样系统,56%仅“根据需要”对患者进行再次手术。48.4%的外科医生已经进行过减压剖腹术,其中66%曾在重症监护病房接受住院培训(p = 0.005)。受访者还指出,未进行剖腹术时与ACS相关的平均死亡率为81%,进行该手术后降至38.5%。只有26%的外科医生知晓WSACS的共识定义和建议,其中83%已经进行过剖腹术(P<0.001)。可以得出结论,尽管葡萄牙普通外科医生认可ACS为一种临床实体,但他们对WSACS的定义和治疗指南却知之甚少,因此迫切需要进行宣传。