严重创伤并发腹腔间室综合征的诊治

Diagnosis and treatment of abdominal compartment syndrome in severe posttrauma

目的:总结严重创伤后并发腹腔间室综合征(abdominal compartment syndrome,ACS)的诊治经验。方法:回顾分析近两年半时间内严重创伤后并发ACS病人的临床资料,10例行开腹减压者入组;1例为电击伤致腹壁裂开、腹腔脏器外露,腹壁裂口处组织呈焦痂、挛缩状态,外露小肠肿胀明显,还纳后强行关腹势必会形成腹腔内高压状态,因此亦行腹腔临时关闭,故入组一并讨论。结果:11例均行腹腔开放减压,1例术后死于酸中毒、多脏器功能衰竭,其余病人二期行关腹或皮瓣移植术后出院。结论:腹部严重创伤合并ACS的病人伤情危重、复杂,早期诊断和及时的开腹减压是抢救的关键,遵循损伤控制原则和给予合理的营养支持治疗是改善预后的重要措施。

Objective To evaluate the diagnosis and treatment of abdominal compartment syndrome（ACS） after severe trauma.Methods The clinical data from patients with ACS after severe trauma within about two and half years were retrospectively reviewed.Ten patients were subjected to abdominal decompression.The abdominal wall was split in 1 patients suffered from electric injury,part of organs in the abdominal cavity were revealed and the small intestinal wall was obviously swelling.If the abdominal wall had been sewed up by force,the intra-abdominal hypertension should be very high.Thus,this patient was also operated by abdominal decompression and combined in this study.Results Eleven patients were operated by abdominal decompression.One patient died from acidosis and multi-organ failure.The rest patients healed up with delayed abdominal closure or skin flap grafting.Conclusions The condition of patients with ACS after severe trauma is always dangerous and complicated.Early diagnosis and temporal abdominal closure are the key of rescue.Following damage control principles and rational nutritional support are also very important.