Nguyen Jonathan, Noory Mary, Capano-Wehrle Lisa, Gaughan John, Hazelton Joshua P
Am Surg. 2018 Nov 1;84(11):1836-1840.
Causes of abdominal compartment syndrome (ACS) are varied and can result from both medical and surgical diseases. Early recognition of ACS and prompt surgical treatment has been shown to improve mortality. We hypothesize that earlier recognition of ACS and earlier involvement by surgical specialists may improve mortality. A retrospective review between July 2010 and July 2015 was performed of adult patients who underwent decompressive laparotomy for ACS. Patients were divided into surgical and medical intensive care units (SICU and MICU) arms. Twenty patients were included (MICU = 12; SICU = 8) without significant difference between the groups. Median time from admission to suspicion for MICU patients was 60 hours 13 hours for SICU patients ( = 0.013). Time from suspicion to surgical consult was 60 minutes 0 minutes, respectively ( = 0.003), however, time from surgical consult to intervention was not different. Mortality rate in the MICU was 83 per cent 12.5 per cent in the SICU ( = 0.005). Patients in the SICU who developed ACS were more quickly diagnosed than those in the MICU. These patients had a shorter time from suspicion of ACS to surgical consultation and eventual surgical intervention, and was associated with improved survival. A multidisciplinary approach, including early surgical consultation, for patients in whom there is a suspicion of ACS may contribute to improved mortality.
腹腔间隔室综合征（ACS）的病因多种多样，可由内科疾病和外科疾病引起。研究表明，早期识别ACS并及时进行手术治疗可降低死亡率。我们推测，更早识别ACS并让外科专家更早参与治疗可能会降低死亡率。对2010年7月至2015年7月期间因ACS接受减压剖腹手术的成年患者进行了回顾性研究。患者被分为外科重症监护病房（SICU）组和内科重症监护病房（MICU）组。共纳入20例患者（MICU组12例；SICU组8例），两组间无显著差异。MICU患者从入院到被怀疑患有ACS的中位时间为60小时，而SICU患者为13小时（P = 0.013）。从怀疑到进行外科会诊的时间分别为60分钟和0分钟（P = 0.003），然而，从外科会诊到干预的时间并无差异。MICU的死亡率为83%，SICU为12.5%（P = 0.005）。发生ACS的SICU患者比MICU患者诊断得更快。这些患者从怀疑ACS到外科会诊及最终手术干预的时间更短，且与生存率提高相关。对于疑似ACS的患者，采用包括早期外科会诊在内的多学科方法可能有助于降低死亡率。
