Division of Trauma and Emergency Surgery, Department of Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan.
Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang-Gung Memorial Hospital, Linkou, Taiwan.
Sci Rep. 2018 Apr 18;8(1):6213. doi: 10.1038/s41598-018-24482-0.
Open abdomen indicates the abdominal fascia is unclosed to abbreviate surgery and to reduce physiological stress. However, complications and difficulties in patient care are often encountered after operation. During May 2008 to March 2013, we performed a prospective protocol-directed observation study regarding open abdomen use in trauma patients. Bogota bag is the temporary abdomen closure initially but negative pressure dressing is used later. A goal-directed ICU care is applied and primary fascial closure is the primary endpoint. There were 242 patients received laparotomy after torso trauma and 84 (34.7%) had open abdomen. Twenty patients soon died within one day and were excluded. Among the included 64 patients, there were 49 (76.6%) males and the mean Injury Severity Score was 31.7. Uncontrolled bleeding was the major indication for open abdomen (64.1%) and the average duration of open abdomen was about 4.2 ± 2.2 days. After treatment, 53(82.8%) had primary fascia closure, which is significant for patient survival (odds ratio 21.6; 95% confidence interval: 3.27-142, p = 0.0014). Factors related to failed primary fascia closure are profound shock during operation, high Sequential Organ Failure Assessment Score in ICU and inadequate urine amount at first 48 hours admission.
腹部开放表示腹壁未关闭，以缩短手术时间并减轻生理压力。然而，手术后经常会遇到患者护理的并发症和困难。2008 年 5 月至 2013 年 3 月，我们对创伤患者腹部开放的使用进行了一项前瞻性方案指导的观察研究。最初使用 Bogota 袋进行临时腹部闭合，但后来使用负压敷料。应用目标导向的 ICU 护理，主要筋膜闭合是主要终点。有 242 例躯干创伤患者接受了剖腹手术，其中 84 例（34.7%）有腹部开放。20 例患者在一天内很快死亡并被排除在外。在纳入的 64 例患者中，有 49 例（76.6%）为男性，损伤严重程度评分平均为 31.7。无法控制的出血是腹部开放的主要指征（64.1%），腹部开放的平均时间约为 4.2±2.2 天。治疗后，53 例（82.8%）患者进行了主要筋膜闭合，这对患者的生存有显著影响（优势比 21.6；95%置信区间：3.27-142，p=0.0014）。与主要筋膜闭合失败相关的因素是手术期间的严重休克、ICU 中连续器官衰竭评估评分高以及入院前 48 小时尿量不足。
