Department of Neurological Intensive Care Unit (NICU), Burdenko Neurosurgical Research Institute, 16 4th Tverskaya-Yamskaya, Moscow, 125047, Russia.
Ann Intensive Care. 2012 Jul 5;2 Suppl 1(Suppl 1):S2. doi: 10.1186/2110-5820-2-S1-S2.
Data on intra-abdominal hypertension [IAH] and secondary abdominal compartment syndrome [ACS] due to neurological insults are limited.
This was a prospective observational study conducted between January 2010 and January 2011 in the neurological ICU [NICU]. Forty-one consecutive patients with sellar region tumors [SRT] were enrolled into the study. If conservative therapy was ineffective in patients with ACS, thoracic epidural anesthesia [EA] was performed. Primary endpoint was defined as the efficacy of conservative treatment and EA in patients with IAH and ACS; secondary endpoint, the influence of IAH and ACS on outcomes.
Of the 41 patients, 13 (31.7%) had normal intra-abdominal pressure and 28 (68.3%) developed IAH, of whom 9 (22%) had ACS (group II). On average, IAH developed on the second postoperative day, while ACS, between the third and the fifth day. Multiple organ dysfunction developed in 3 (23.1%) patients of group I and in 23 (82%) patients of group II (p = 0.0003). Ileus due to gastrointestinal dysmotility was present in 6 (46.2%) patients of group I and in all patients of group II (p = 0.0001). Significant risk factors for ileus were diencephalon dysfunction (whole group - in 33 patients (80.5%); group I - in 6 patients (46.2%); group II - in 27 patients (96.4%), p = 0.0002) and sepsis (whole group - in 8 patients (19.5%); group I - no cases; group II - in 8 patients (28.6%), p = 0.03). Conservative treatment was effective in the majority of patients (78.9%) with IAH and only in 3 (33%) patients with ACS. Thoracic EA was performed in four patients with ACS with success. Length of stay in the NICU was 6.5 ± 4.6 days in group I and 24.1 ± 25.7 (p = 0.02) days in group II. Five out of nine (55.6%) patients with ACS died. None of these patients received EA. All patients with EA had favorable outcomes.
The development of IAH is common after SRT surgery. If conservative treatment is ineffective, EA can be considered in patients with secondary ACS. Further studies are warranted.
神经损伤导致的腹腔内高压[IAH]和继发性腹腔间隔室综合征[ACS]的数据有限。
这是一项于 2010 年 1 月至 2011 年 1 月在神经重症监护病房[NICU]进行的前瞻性观察研究。共纳入 41 例鞍区肿瘤[SRT]连续患者。如果 ACS 患者的保守治疗无效，则进行胸段硬膜外麻醉[EA]。主要终点定义为 IAH 和 ACS 患者保守治疗和 EA 的疗效；次要终点为 IAH 和 ACS 对结局的影响。
41 例患者中，13 例（31.7%）腹腔内压正常，28 例（68.3%）发生 IAH，其中 9 例（22%）发生 ACS（II 组）。IAH 平均在术后第 2 天发生，而 ACS 在第 3 至第 5 天发生。第 I 组中有 3 例（23.1%）患者出现多器官功能障碍，第 II 组中有 23 例（82%）患者出现多器官功能障碍（p = 0.0003）。第 I 组中有 6 例（46.2%）患者和第 II 组所有患者（p = 0.0001）均出现因胃肠道动力障碍引起的肠梗阻。肠梗阻的显著危险因素是间脑功能障碍（全组-33 例患者（80.5%）；第 I 组-6 例患者（46.2%）；第 II 组-27 例患者（96.4%），p = 0.0002）和脓毒症（全组-8 例患者（19.5%）；第 I 组-无病例；第 II 组-8 例患者（28.6%），p = 0.03）。IAH 患者多数（78.9%）经保守治疗有效，仅 3 例（33%）ACS 患者有效。4 例 ACS 患者行胸段 EA 成功。第 I 组 NICU 住院时间为 6.5 ± 4.6 天，第 II 组为 24.1 ± 25.7（p = 0.02）天。9 例 ACS 患者中有 5 例死亡。这些患者均未接受 EA。所有接受 EA 的患者均有良好的预后。
SRT 术后 IAH 很常见。如果保守治疗无效，可考虑对继发性 ACS 患者行 EA。需要进一步研究。
