Bleszynski Michael S, Chan Tiffany, Buczkowski Andrzej K
Division of General Surgery, Department of General Surgery, University of British Columbia (UBC), Vancouver, BC, Canada.
Division of General Surgery, Department of General Surgery, University of British Columbia (UBC), Vancouver, BC, Canada.
Am J Surg. 2017 May;213(5):849-855. doi: 10.1016/j.amjsurg.2017.03.037. Epub 2017 Apr 6.
Open abdomen with vacuum assisted closure (VAC) is an alternate method to primary abdominal closure (PAC) in select situations for the management of severe surgical abdominal sepsis or septic shock. Peritoneal cytokines may potentially correlate with deranged physiology and help stratify severity of sepsis. The primary objective of the study was to identify if cytokines can differentiate between patients who underwent PAC or VAC at primary source control laparotomy (SCL).
Prospective case series including patients with severe abdominal sepsis/septic shock requiring urgent SCL. Peritoneal fluid (PF) was collected intra-operatively and blood samples were collected pre- and post SCL. Samples were analyzed with a Cytokine 30-plex Panel. APACHE-IV was used as a measure of disease severity between groups.
4 PAC and 8 VAC patients were included. PF concentrations of IL 6, IL-17, IL-5 and HGF were significantly elevated in VAC compared to PAC. Serum RANTES was increased in survivors compared to non-survivors.
Patients who received VAC management had a more severe degree of local abdominal sepsis based on significantly elevated peritoneal cytokines.
在处理严重的外科腹部脓毒症或脓毒性休克的特定情况下，开放性腹部联合负压封闭引流（VAC）是一种替代一期腹壁缝合（PAC）的方法。腹膜细胞因子可能与生理紊乱相关，并有助于对脓毒症的严重程度进行分层。本研究的主要目的是确定细胞因子是否能够区分在一期源头控制剖腹术（SCL）中接受PAC或VAC治疗的患者。
前瞻性病例系列研究，纳入需要紧急SCL的严重腹部脓毒症/脓毒性休克患者。术中收集腹腔积液（PF），并在SCL前后采集血样。样本采用细胞因子30联检试剂盒进行分析。APACHE-IV用于衡量两组之间的疾病严重程度。
纳入4例接受PAC治疗的患者和8例接受VAC治疗的患者。与PAC组相比，VAC组的IL-6、IL-17、IL-5和HGF的PF浓度显著升高。与非幸存者相比，幸存者的血清调节活化正常T细胞表达和分泌因子（RANTES）升高。
基于腹腔细胞因子显著升高，接受VAC治疗的患者局部腹部脓毒症程度更严重。
