Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, China.
Department of Orthopaedic Surgery, The Third Hospital of HeBei Medical University, Zi Qiang Avenue 139, Shijiazhuang, China.
Injury. 2019 Apr;50(4):919-925. doi: 10.1016/j.injury.2019.03.037. Epub 2019 Mar 28.
Limited data exist regarding intraabdominal hypertension/abdominal compartment syndrome (IAH/ACS) after pelvic fractures. We aimed to explore risk factors for IAH/ACS in pelvic fracture patients, assess the physiological effects of decompressive laparotomy (DL) on IAH/ACS, and generate an algorithm to manage IAH/ACS after pelvic fracture.
Pelvic fracture patients were included based on the presence of IAH/ACS. Intraabdominal pressure (IAP) was measured through a Foley catheter. DL was performed in patients with refractory IAH or ACS. Multivariable linear regression was applied to assess associations between IAP levels (≥12 mmHg) and age, sex, injury severity score (ISS), pelvic fracture, volume of resuscitation fluids over 24 h and hemoglobin values. The Wilcoxon signed-rank test for paired samples was used to compare variables before and after DL.
Among 455 pelvic fracture patients, 44 (9.7%) and 5 (1.1%) were diagnosed with IAH and ACS, respectively. The volume of resuscitation fluids over 24 h exhibited a significant positive correlation with IAP levels (≥12 mmHg) (p = 0.002). The main findings during DL were edematous bowel (11/20) and retroperitoneal hematoma (7/20). DL caused a significant decrease in the mean IAP from 24.4 ± 8.5 mmHg to 13.4 ± 4.0 mmHg (p < 0.0001). Physiological parameters (APP, PaO2/FIO2 ratio, PIP, arterial lactate and UOP) were significantly improved after DL. The mortality rate was 15% in patients who underwent DL and 40% in ACS patients.
IAH/ACS is common in pelvic fracture patients. The most effective method to decrease IAP in pelvic fracture patients is DL. Prophylactic DL is important for decreasing mortality as it prevents IAH from progressing to ACS. Massive fluid resuscitation is a significant risk factor for IAH/ACS. A pathway incorporating prophylactic/therapeutic DL and optimized fluid resuscitation to prevent and manage IAH/ACS after pelvic fractures may reduce morbidity and mortality.
有关骨盆骨折后腹腔内高压/腹腔间隔室综合征（IAH/ACS）的数据有限。我们旨在探讨骨盆骨折患者发生 IAH/ACS 的危险因素，评估减压剖腹术（DL）对 IAH/ACS 的生理影响，并生成一种管理骨盆骨折后 IAH/ACS 的算法。
根据 IAH/ACS 的存在纳入骨盆骨折患者。通过 Foley 导管测量腹腔内压（IAP）。在难治性 IAH 或 ACS 患者中进行 DL。应用多变量线性回归评估 IAP 水平（≥12mmHg）与年龄、性别、损伤严重程度评分（ISS）、骨盆骨折、24 小时内复苏液量和血红蛋白值之间的关系。采用配对样本 Wilcoxon 符号秩检验比较 DL 前后的变量。
在 455 例骨盆骨折患者中，分别有 44 例（9.7%）和 5 例（1.1%）诊断为 IAH 和 ACS。24 小时内复苏液量与 IAP 水平（≥12mmHg）呈显著正相关（p=0.002）。DL 期间的主要发现是水肿性肠（11/20）和腹膜后血肿（7/20）。DL 可使平均 IAP 从 24.4±8.5mmHg 显著降低至 13.4±4.0mmHg（p<0.0001）。DL 后生理参数（APP、PaO2/FIO2 比值、PIP、动脉乳酸和 UOP）显著改善。行 DL 的患者死亡率为 15%，ACS 患者死亡率为 40%。
IAH/ACS 在骨盆骨折患者中很常见。降低骨盆骨折患者 IAP 的最有效方法是 DL。预防性 DL 对于降低死亡率很重要，因为它可以防止 IAH 进展为 ACS。大量液体复苏是 IAH/ACS 的一个重要危险因素。包含预防性/治疗性 DL 和优化液体复苏以预防和管理骨盆骨折后 IAH/ACS 的途径可能会降低发病率和死亡率。
