《成人腹腔高压和腹腔间隔室综合征诊治中国急诊专家共识(2024)》解读

Interpretation of emergency expert consensus on diagnosis and treatment of intra-abdominal hypertension and abdominal compartment syndrome in adults in China(2024)

腹腔高压(intra-abdominal hypertension,IAH)和腹腔间隔室综合征(abdominal compartment syndrome,ACS)是常见的急诊危重症,给急诊科医生带来严峻挑战。自2013年世界腹腔间隔室综合征协会发布IAH/ACS诊疗指南以来,近10年的研究为IAH/ACS临床实践增加了新的证据。由中华医学会急诊医学分会等组织的专家,在总结国内外指南文献和近10年研究成果的基础上,全面总结了IAH/ACS的定义、流行病学、病因、诊断、治疗和预防等,结合急诊科工作特点,制定了“成人腹腔高压和腹腔间隔室综合征诊治中国急诊专家共识(2024)”(简称“共识”),共提出22条推荐意见。“共识”强调急诊科医务人员需高度重视IAH/ACS,熟练掌握流程化的筛查和诊疗方法;并强调采取包括祛除病因、降低腹腔内压(intra-abdominal pressure,IAP)、器官功能支持等在内的综合诊疗措施;建议根据IAP水平和器官功能损伤严重程度进行分层诊疗。此外,共识还增加了中医药治疗、床旁实时超声应用和预防及阻断等内容,为急诊IAH/ACS患者的诊疗提供了更为全面的指导。

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)are frequently encountered emergencies that pose serious challenges to emergency physicians.Since the diagnosis and treatment guideline of IAH/ACS released by the World Society of the Abdominal Compartment Syndrome in 2013,researches during the last 10 years have added new evidence to the clinical practice in this area.Chinese experts were assembled by the Emergency Medicine Branch of Chinese Medical Association and other organizations and comprehensively summarized the definition,epidemiology,etiology,diagnosis,treatment,and prevention measures of IAH/ACS.They drafted the"Emergency expert consensus on diagnosis and treatment of intra-abdominal hypertension and abdominal compartment syndrome in adults in China(2024)"(hereinafter referred to as"Consensus"),proposing a total of 22 recommendations,based on domestic and international guidelines,research findings during the past decade,as well as the unique characteristics of emergency practice.The"Consensus"emphasized that emergency medical staff should pay close attention to IAH/ACS and be proficient in standardized screening,diagnosis and treatment protocols.It emphasized adopting comprehensive diagnostic and treatment measures,including elimination of underlying causes,reduction of intra-abdominal pressure(IAP)and organ support,etc.and recommended stratified diagnosis and treatment measures according to the IAP level and the severity of organ dysfunction.In addition,traditional Chinese medicine treatment,point-of-care ultrasound application,and prevention and blocking measures were added in the"Consensus",providing more comprehensive guidance for the diagnosis and treatment of emergency IAH/ACS patients.