腹腔扩容术防治创伤后腹腔间隙综合征

摘要

目的 探讨腹腔扩容术防治创伤后腹腔间隙综合征的效果.方法 回顾性分析了2007年11月~2012年3月我院创伤中心收治的22例严重创伤患者(腹内高压6例、腹腔间隙综合征16例)的临床资料和腹腔扩容术的治疗结果.所有患者均接受腹腔扩容术治疗,首先探查全腹腔,控制活动性出血及感染源等;然后将大网膜平铺于切口下方,根据切口大小将2~3块Vacuseal材料置于大网膜表面,四周与前鞘、白线或皮肤缝合,引流管维持60~80mmHg的持续负压,7~14d后通过Ⅱ期缝合行确定性腹壁重建.结果本组22例救治成功16例(成功率72.73%);死亡6例(27.27%),4例死于多器官功能衰竭(MODS),1例死于严重颅脑损伤所致脑疝,1例吸毒、结肠脾曲刀刺伤术后转入患者放弃治疗.22例手术患者手术前后膀胱压值间差别有统计学意义(P<0.01).结论 腹腔扩容术不仅保护腹腔内容物,便于再次探查手术,更利于清除腹腔积液并计量,减轻腹腔组织水肿,控制感染,逆转组织水肿并帮助皮肤和筋膜靠拢,利于后期关闭筋膜和腹壁,对于防治创伤后腹腔间隙综合征(ACS)的效果显著,值得临床广泛应用.%Objective To discuss the effect of intra -abdominal volume increment (IAVI) in preventing and treating abdominal compartment syndrome (ACS) following trauma. Methods Data of 22 patients were retrospectively analyzed ,including 6 cases of intra-abdominal hypertension (IAH) and 16 cases of ACS, who were admitted into our hospital from Nov. 2007 to Mar. 2012. All patients received intra - abdominal volume increment. The steps were as follow. Firstly, laparotomy was performed , active bleeding and source of infection were controlled. Then greater omentum was put under the incision , the Vacuseal dressings were applied on the greater omentum , and the circumference was sutured with protheca , linea alba or skin. Continuous negative pressure was maintained 60-80mmHg using the drainage tube , and the definitive abdominal wall reconstruction was conducted by secondary su -ture. Results Successful treatment was achieved in 16 patients ,death in 6 patients. The death cases included 4 cases of MODS , 1 case of cerebral hernia and 1 case of refusing any treatment. There was significant difference in vesical pressure. Conclusion IAVI has advantages of protecting abdominal organ , being beneficial for performing second laparotomy and cleaning and counting seroperitoneum , mitigating swelling of abdominal tissue , controlling infection and reversing tissue swelling . The IAVI also helps to close the skin and fascia , which is beneficial for closing fascia and abdominal wall in the later stage. It has remarkable effect on preventing and treating abdominal compart -ment syndrome (ACS) , and therefore it is suitable for more extensive application in clinic.