腹腔开放治疗重症急性胰腺炎病人合并腹腔间室综合征的回顾性研究

The clinical effect of open abdominal decompression in SAP patients with ACS

目的:回顾重症急性胰腺炎(SAP)病人合并腹腔间室综合征(ACS)接受腹腔开放术后器官功能的变化及临床结局,分析腹腔开放治疗对病人预后的影响和存在的问题。方法:收集SAP合并ACS并且接受腹腔开放减压的病人10例。记录腹腔开放前后血流动力学参数、器官功能指标和病人的临床结局。结果:本研究共纳入10例病人,平均年龄为(47±13)岁,胆源性胰腺炎为主要患病原因(6/10)。行腹腔开放减压术的具体原因分别为血流动力学紊乱5例,呼吸功能衰竭3例,肾功能衰竭1例,腹腔出血1例。腹腔开放减压后腹腔压力(IAP)明显下降[(30.4±3.062)mm Hg vs(14.5±1.179)mm Hg,P<0.05)],但血流动力学和器官功能指标变化趋势各异。10例病人中死亡5例,病死率为50%。结论:腹腔开放减压可明显降低SAP合并ACS病人的IAP,但仍会导致继发性器官功能损害,影响ACS病人的预后。

Objictive： To review the effect of open abdominal decompression in SAP patients combined ACS. Methods： From January 1, 2003 to December 31, 2011, SAP patients combined ACS who were admitted to Institute of General Surgery, Jinling Hospital and underwent open abdominal decompression were selected. Hemodynamic parameters, organ function indicators and clinical outcomes were recorded. Results： 10 patients were included in the study, of whom the average age was 47± 13 years old and gallstone was the main cause of pancreatitis （6/10）. The reasons for open abdominal decompression included hemodynamic disturbances （ 5/10）, respiratory failure （ 3/10 ） renal failure （ 1/ 10） and abdominal bleeding （1/10）. IAP decreased significantly after open abdominal decompression （30.4 ±3. 062 mmHg vs 14.5 ± 1. 179 mmHg, P 〈0.05）, but the hemodynamic parameters and organ function changed variously. Five cases of 10 patients died. The mortality was 50%. Conclusion： Open abdominal decompression can significantly reduce the IAP in SAP patients combined ACS. However, the sharp decrease of IAP after open abdominal decompression may cause hemodynamic disorders, respiratory instability and even further organ damage. Therefore, open abdominal decompression can cause secondary organ dysfunction and affect patients＇prognosis.