Ruiz-Castilla M, Barret J P, Sanz D, Aguilera J, Serracanta J, García V, Collado J M
Department of Plastic Aesthetic, and Reconstructive Surgery and Burns Center, Vall d'Hebron University Hospital, VHIR-Vall d'Hebron Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
Department of Plastic Aesthetic, and Reconstructive Surgery and Burns Center, Vall d'Hebron University Hospital, VHIR-Vall d'Hebron Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
Burns. 2014 Jun;40(4):719-24. doi: 10.1016/j.burns.2013.09.021. Epub 2013 Nov 5.
Although severely burned patients are at a high risk of developing intra-abdominal hypertension (IAH: IAP>12 mmHg) and Abdominal Compartment Syndrome (ACS) (IAP ≥ 20 mmHg), few data about its incidence and prevalence is available. Our aim was to determine the incidence and prevalence of IAH and ACS in patients with severe burns in our geographical setting. A pilot prospective, observational study was performed at the Burns Unit of the Plastic Surgery Department in Vall d'Hebron University Hospital (Barcelona), during a 12-month period. All patients with age ≥ 18 years old and burns >20% of the total body surface area (TBSA) were considered for inclusion. Patients who did not require urinary catheterization via the urethra were excluded. All patients included were followed during the first five days from their admission. Results are expressed as median (interquartile range) or frequency (percentage). During the study period, 303 patients were admitted to the Burns Unit. Twenty-five patients were included in the study (21 [84%] male, 4 [16%] female; age 42 [30-69 years]; TBSA burned 33 [25-58]%; all patients presented deep second-degree and/or third-degree burns). Eighteen (72%) patients met criteria for IAH, but only one (4%) developed ACS. The incidence of IAH and ACS was 0.56 and 0.04 cases/patient-day, respectively. Patients with IAH presented higher number of organs failure (2 [0-2.2] vs 0 [0-0]; p = 0.03). Patients with >20% TBSA burned presented a very high prevalence of IAH. Development of organ failure occurred even at moderately increased values of IAP. In this scenario, monitoring of IAP is the first step for establishing the importance of IAH/ACS in this patient population.
尽管严重烧伤患者发生腹内高压（IAH：腹内压>12 mmHg）和腹腔间隔室综合征（ACS）（腹内压≥20 mmHg）的风险很高，但关于其发病率和患病率的数据却很少。我们的目的是确定在我们所在地区严重烧伤患者中IAH和ACS的发病率和患病率。在12个月期间，于巴塞罗那瓦尔德希伯伦大学医院整形外科烧伤科进行了一项前瞻性试点观察研究。纳入所有年龄≥18岁且烧伤面积>全身表面积（TBSA）20%的患者。排除不需要经尿道留置导尿管的患者。所有纳入患者在入院后的前五天进行随访。结果以中位数（四分位间距）或频率（百分比）表示。在研究期间，303名患者入住烧伤科。25名患者纳入研究（男性21例[84%]，女性4例[16%]；年龄42岁[30 - 69岁]；TBSA烧伤面积33%[25 - 58%]；所有患者均为深二度和/或三度烧伤）。18例（72%）患者符合IAH标准，但只有1例（4%）发生ACS。IAH和ACS的发病率分别为0.56例/患者日和0.04例/患者日。IAH患者出现器官衰竭的数量更多（2例[0 - 2.2]对0例[0 - 0]；p = 0.03）。TBSA烧伤面积>20%的患者IAH患病率非常高。即使腹内压中度升高也会发生器官衰竭。在这种情况下，监测腹内压是确定IAH/ACS在该患者群体中重要性的第一步。
