Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
Lancet. 2014 Oct 18;384(9952):1466-75. doi: 10.1016/S0140-6736(14)61689-5. Epub 2014 Oct 17.
Postinjury abdominal compartment syndrome (ACS) is an example of a deadly clinical occurrence that was eliminated by strategic research and focused preventions. In the 1990s, the syndrome emerged with the widespread use of damage control surgery and aggressive crystalloid-based resuscitation. Patients who previously exsanguinated on the operating table made it to intensive care units, but then developed highly lethal hyperacute respiratory, renal, and cardiac failure due to increased abdominal pressure. Among many factors, delayed haemorrhage control and preload driven excessive use of crystalloid resuscitation were identified as modifiable predictors. The surrogate effect of preventive strategies, including the challenge of the 40-year-old standard of large volume crystalloid resuscitation for traumatic shock, greatly reduced cases of ACS. The discoveries were rapidly translated to civilian and military trauma surgical practices and fundamentally changed the way trauma patients are resuscitated today with substantially improved outcomes.
创伤后腹间隔室综合征（ACS）是一个通过战略性研究和集中预防消除的致命临床事件的例子。20 世纪 90 年代，随着损伤控制性手术和积极的晶体复苏的广泛应用，该综合征出现了。以前在手术台上失血过多的患者进入了重症监护病房，但随后由于腹内压升高而发生了高度致命的超急性呼吸、肾脏和心脏衰竭。在许多因素中，延迟止血和前负荷驱动的晶体复苏的过度使用被确定为可改变的预测因素。包括对 40 年来创伤性休克大量晶体复苏标准的挑战在内的预防策略的替代效果，大大减少了 ACS 的发生。这些发现迅速转化为民用和军事创伤外科实践，并从根本上改变了今天对创伤患者进行复苏的方式，使结果得到了显著改善。
