Smit M, Buddingh K T, Bosma B, Nieuwenhuijs V B, Hofker H S, Zijlstra J G
Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
World J Surg. 2016 Jun;40(6):1454-61. doi: 10.1007/s00268-015-3388-7.
Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS, in particular the occurrence of intestinal ischemia.
The medical records of all patients admitted with severe acute pancreatitis admitted to the ICU of a tertiary referral center were reviewed. The criteria proposed by the World Society of the Abdominal Compartment Syndrome (WSACS) were used to determine whether patients had IAH or ACS.
Fifty-nine patients with severe acute pancreatitis were identified. Intra-abdominal pressure (IAP) measurements were performed in 29 patients (49.2 %). IAH was present in all patients (29/29). ACS developed in 13/29 (44.8 %) patients. Ten patients with ACS underwent decompressive laparotomy. A large proportion of patients with ACS had intra-abdominal ischemia upon laparotomy: 8/13 (61.5 %). Mortality was high in both the ACS group and the IAH group.
This study confirms that ACS is common in severe acute pancreatitis. Intra-abdominal ischemia occurs in a large proportion of patients with ACS. Swift surgical intervention may be indicated when conservative measures fail in patients with ACS. National and international guidelines need to be updated so that routine IAP measurements become standard of care for patients with severe acute pancreatitis in the ICU.
重症急性胰腺炎可能并发腹腔内高压（IAH）、腹腔间隔室综合征（ACS）和肠道缺血。本回顾性研究的目的是描述重症急性胰腺炎合并ACS患者的发病率、治疗方法及预后，尤其是肠道缺血的发生情况。
回顾了一家三级转诊中心重症监护病房收治的所有重症急性胰腺炎患者的病历。采用世界腹腔间隔室综合征协会（WSACS）提出的标准来确定患者是否患有IAH或ACS。
共确定59例重症急性胰腺炎患者。29例患者（49.2%）进行了腹腔内压力（IAP）测量。所有患者（29/29）均存在IAH。13/29（44.8%）例患者发展为ACS。10例ACS患者接受了减压剖腹手术。很大一部分ACS患者在剖腹手术时存在腹腔内缺血：8/13（61.5%）。ACS组和IAH组的死亡率均较高。
本研究证实ACS在重症急性胰腺炎中很常见。很大一部分ACS患者存在腹腔内缺血。当ACS患者保守治疗失败时，可能需要迅速进行手术干预。需要更新国家和国际指南，以便将常规IAP测量作为重症监护病房中重症急性胰腺炎患者的标准治疗方法。
