复杂腹壁疝修补术后腹腔内高压和腹腔间隔室综合征的成功非手术治疗：病例系列。
Successful non-operative management of intraabdominal hypertension and abdominal compartment syndrome after complex ventral hernia repair: a case series.
机构信息
Department of Surgery, Rush Medical College, 1725 W. Harrison St., Suite 810/818, Chicago, IL, USA.
出版信息
Am J Surg. 2018 Oct;216(4):819-823. doi: 10.1016/j.amjsurg.2018.07.063. Epub 2018 Sep 14.
BACKGROUND
Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are devastating complications of surgery. Patients who undergo complex ventral hernia repair (CVHR) may be at risk for IAH and ACS.
METHODS
We performed a retrospective review of 175 patients who underwent CVHR by a single surgeon. Body mass index (BMI), prior hernia repair, operative time, bladder pressure, serum creatinine, sedation, paralytic therapy, and ventilator support were reviewed.
RESULTS
IAH was identified in 33 patients; 11 patients developed ACS. Paralytic therapy was employed in 29 patients for an average of 1.4 days. Elevated BMI was independently associated with an increased risk of IAH (p = 0.006) and ACS (p = 0.02).
CONCLUSION
Patients who undergo CVHR are at risk of developing IAH and ACS in the postoperative period. Elevated BMI and longer operative time are independent risk factors for the development of IAH. IAH and ACS can be successfully managed with surgical critical care.
背景
腹腔内高压（IAH）和腹腔间隔室综合征（ACS）是手术的毁灭性并发症。接受复杂的腹侧疝修补术（CVHR）的患者可能有发生 IAH 和 ACS 的风险。
方法
我们对一位外科医生进行的 175 例 CVHR 患者进行了回顾性研究。回顾了体重指数（BMI）、既往疝修补术、手术时间、膀胱压、血清肌酐、镇静、麻痹治疗和呼吸机支持情况。
结果
33 例患者发生 IAH，11 例患者发生 ACS。29 例患者使用麻痹治疗，平均 1.4 天。BMI 升高与 IAH（p=0.006）和 ACS（p=0.02）的风险增加独立相关。
结论
接受 CVHR 的患者在术后有发生 IAH 和 ACS 的风险。BMI 升高和手术时间延长是 IAH 发展的独立危险因素。使用外科重症监护可以成功治疗 IAH 和 ACS。
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