Mahmood Ismail, Mahmood Saeed, Parchani Ashok, Kumar Suresh, El-Menyar Ayman, Zarour Ahmad, Al-Thani Hassan, Latifi Rifat
Trauma Intensive Care Unit, Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
ANZ J Surg. 2014 Mar;84(3):166-71. doi: 10.1111/ans.12169. Epub 2013 Apr 9.
This study aimed to determine the incidence and outcome of post-traumatic (PT) intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) after the advances in haemostatic resuscitation.
This is a prospective cohort study from January 2009-December 2011 involving patients with PT haemorrhagic shock. Patients' demographics, fluid resuscitation (<24 h) and damage control laparotomy (DCL), morbidity and mortality were assessed. Patients were divided into group 1 (no DCL) and group 2 (DCL needed). Further, group 1 was subdivided into three subgroups (IA pressure (IAP) <12, 12-20 and >20 mmHg).
One hundred seventeen patients enrolled in the study (102 in group 1 and 15 in group 2) with a mean age of 35 ± 14, injury severity score (ISS) of 23 ± 10, base deficit of -8.7 ± 2.7 mmol/L, serum lactate of 4.6 ± 2.5 mg/dL and haemoglobin level of 8.8 ± 2. Patients received 7 ± 5 red blood cell units, 6 ± 4.7 fresh frozen plasma units and 8.3 ± 3 L of crystalloid per 24 h. There were significant difference between the two groups regarding crystalloid volume, blood transfusion, base deficit and intensive care unit length of stay. However, mortality was higher in group 2 (20% versus 6%). IAP ≥ 20 mmHg was reported in 16.7% patients, while 25.5% had IAP < 12 and 57.8% had IAP of 12-20 mmHg. Patients with IAP > 20 had worse metabolic acidosis and received more blood compared with other groups. One patient died because of ACS (0.9%). Overall multiorgan failure and mortality were 5 and 7.7%, respectively.
With current practice of minimal fluid resuscitation and liberal use of damage control strategies among trauma patients, the IAH was common transient phenomena but the incidence of ACS is remarkably low.
本研究旨在确定止血复苏进展后创伤后（PT）腹腔内高压（IAH）和腹腔间隔室综合征（ACS）的发生率及转归。
这是一项2009年1月至2011年12月的前瞻性队列研究，纳入PT出血性休克患者。评估患者的人口统计学资料、液体复苏（<24小时）和损伤控制剖腹术（DCL）、发病率和死亡率。患者分为1组（无需DCL）和2组（需要DCL）。此外，1组又细分为三个亚组（腹腔内压力（IAP）<12、12 - 20和>20 mmHg）。
117例患者纳入研究（1组102例，2组15例），平均年龄35±14岁，损伤严重程度评分（ISS）为23±10，碱缺失为-8.7±2.7 mmol/L，血清乳酸为4.6±2.5 mg/dL，血红蛋白水平为8.8±2。患者每24小时接受7±5个红细胞单位、6±4.7个新鲜冰冻血浆单位和8.3±3 L晶体液。两组在晶体液量、输血、碱缺失和重症监护病房住院时间方面存在显著差异。然而，2组死亡率更高（20%对6%）。16.7%的患者报告IAP≥20 mmHg，而25.5%的患者IAP<12 mmHg，57.8%的患者IAP为12 - 20 mmHg。与其他组相比，IAP>20的患者代谢性酸中毒更严重，输血更多。1例患者因ACS死亡（0.9%）。总体多器官功能衰竭和死亡率分别为5%和7.7%。
在目前创伤患者中采用最小化液体复苏和广泛使用损伤控制策略的情况下，IAH是常见的短暂现象，但ACS的发生率极低。
