Current Diagnosis and Treatment of Abdominal Compartment Syndrome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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贾乾斌

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腹腔间隔室综合征

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腹腔间隔室综合征（abdominal compartment syndrome, ACS）是一个近百年来未引起重视的问题。19世纪末至20世纪初, Marey、Heinricios和Wendt等发现，腹内压升高到27~46 cmH2O时可导致动物呼吸功能不全、心血管功能紊乱和肾功能不全，甚至死亡。随着基础医学和临床研究的进展，已证实腹内压升高对多器官系统功能有影响。Kron等［1］在80年代首次使用ACS一词来描述腹主动脉瘤手术后腹内高压（intraabdominal hypertension, IAH）所致的病理生理学改变。目前，ACS是指由于IAH所导致的心血管、肺、肾等内脏及腹壁、腹壁伤口和颅内损害，而与引起IAH的原因无关，它还包括IAH对内脏的单独损害以及与心、肺、肾功能不全无关的其它不利影响。其实在外科实践中，特别是在危重患者治疗过程中，腹腔压力升高导致多器官系统功能受损的情况相当普遍。但文献报道的ACS的发生率差别很大，一般为1%~14%［2，3］，最高达52%［4］，这可能是由于各家报道的病例不同，病情严重程度不同所致。

Citation： 贾乾斌. Current Diagnosis and Treatment of Abdominal Compartment Syndrome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2003, 10(1): 71-74. doi: Copy

1.	Kron IL, Harman PK, Nolan SP. The measurement of intraabdominal pressure as a criterion for abdominal reexploration [J]. Ann Surg，1984; 199(1)∶28.
2.	Hong JJ, Cohn SM, Perez JM，et al. Prospective study of the incidence and outcome of intraabdominal hypertension and the abdominal compartment syndrome [J]. Br J Surg, 2002; 89(5)∶591.
3.	Meldrum DR, Moore FA, Moore EE,et al. Prospective characterization and selective management of the abdominal compartment syndrome [J]. Am J Surg, 1997; 174(6)∶66.
4.	Ivatury RR, Porter JM, Simon RJ,et al. Intraabdominal hypertension after lifethreatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome [J]. J Trauma, 1998; 44(6)∶1016.
5.	Bloomfield GL, Blocher CR, Fakhry IF, et al. Elevated intraabdominal pressure increases plasma renin activity and aldosterone levels [J]. J Trauma, 1997; 42(6)∶997.
6.	Diebel LN, Dulchavsky SA, Brown WJ. Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome [J].J Trauma, 1997; 43(5)∶852.
7.	Simon RJ, Friedlander MH, Ivatury RR, et al. Hemorrhage lower the threshold for intraabdominal hypertension(IAH) induced pulmonary dysfunction [J]. J Trauma, 1997; 42(3)∶398.
8.	Bloomfield GL, Ridings PC, Blocher CR, et al. A proposed relationship between increased intraabdominal, intrathoracic, and intracranial pressure [J]. Crit Care Med,1997; 25(3)∶496.
9.	Bloomfield GL, Dalton JM, Sugerman HJ, et al. Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma [J]. J Trauma, 1995; 39(6)∶1168.
10.	Ertel W, Oberholzer A, Platz A, et al. Incidence and clinical pattern of the abdominal compartment syndrome after “damagecontrol” laparotomy in 311 patients with severe abdominal and/or pelvic trauma [J]. Crit Care Med, 2000; 28(6)∶1747.
11.	Chen RJ, Fang JF, Chen MF. Intraabdominal pressure monitoring as a guideline in the nonoperative management of blunt hepatic trauma [J].J Trauma, 2001; 51(1)∶44.
12.	Sugrue M, Buist MD, Lee A, et al.Intraabdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique [J].Intensive Care Med, 1994; 20(8)∶588.
13.	Cheatham ML, White MW, Sagraves SG, et al. Abdominal perfusion pressure: a superior parameter in the assessment of intraabdominal hypertension [J]. J Trauma, 2000; 49(4)∶621.
14.	Burch JM, Moore EE, Moore FA, et al. The abdominal compartment syndrome [J]. Surg Clin North Am, 1996; 76(4)∶833.
15.	Moore EE. Staged laparotomy for the hypothermia, acidosis, and coagulopathy syndrome [J].Am J Surg, 1996; 172(5)∶405.
16.	Kopelman T, Harris C, Miller R, et al. Abdominal compartment syndrome in patients with isolated extraperitoneal injuries [J]. J Trauma, 2000; 49(4)∶744.
17.	Burrows R,Edington J,Robbs JV.A wolf in wolf’s clothing: the abdominal compartment syndrome [J].S Afr Med J,1995; 85(1)∶46.
18.	Offner PJ, de Souza AL, Moore EE, et al. Avoidance of abdominal compartment syndrome in damagecontrol laparotomy after trauma [J]. Arch Surg, 2001; 136(6)∶676.

1. Kron IL, Harman PK, Nolan SP. The measurement of intraabdominal pressure as a criterion for abdominal reexploration [J]. Ann Surg，1984; 199(1)∶28.
2. Hong JJ, Cohn SM, Perez JM，et al. Prospective study of the incidence and outcome of intraabdominal hypertension and the abdominal compartment syndrome [J]. Br J Surg, 2002; 89(5)∶591.
3. Meldrum DR, Moore FA, Moore EE,et al. Prospective characterization and selective management of the abdominal compartment syndrome [J]. Am J Surg, 1997; 174(6)∶66.
4. Ivatury RR, Porter JM, Simon RJ,et al. Intraabdominal hypertension after lifethreatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome [J]. J Trauma, 1998; 44(6)∶1016.
5. Bloomfield GL, Blocher CR, Fakhry IF, et al. Elevated intraabdominal pressure increases plasma renin activity and aldosterone levels [J]. J Trauma, 1997; 42(6)∶997.
6. Diebel LN, Dulchavsky SA, Brown WJ. Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome [J].J Trauma, 1997; 43(5)∶852.
7. Simon RJ, Friedlander MH, Ivatury RR, et al. Hemorrhage lower the threshold for intraabdominal hypertension(IAH) induced pulmonary dysfunction [J]. J Trauma, 1997; 42(3)∶398.
8. Bloomfield GL, Ridings PC, Blocher CR, et al. A proposed relationship between increased intraabdominal, intrathoracic, and intracranial pressure [J]. Crit Care Med,1997; 25(3)∶496.
9. Bloomfield GL, Dalton JM, Sugerman HJ, et al. Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma [J]. J Trauma, 1995; 39(6)∶1168.
10. Ertel W, Oberholzer A, Platz A, et al. Incidence and clinical pattern of the abdominal compartment syndrome after “damagecontrol” laparotomy in 311 patients with severe abdominal and/or pelvic trauma [J]. Crit Care Med, 2000; 28(6)∶1747.
11. Chen RJ, Fang JF, Chen MF. Intraabdominal pressure monitoring as a guideline in the nonoperative management of blunt hepatic trauma [J].J Trauma, 2001; 51(1)∶44.
12. Sugrue M, Buist MD, Lee A, et al.Intraabdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique [J].Intensive Care Med, 1994; 20(8)∶588.
13. Cheatham ML, White MW, Sagraves SG, et al. Abdominal perfusion pressure: a superior parameter in the assessment of intraabdominal hypertension [J]. J Trauma, 2000; 49(4)∶621.
14. Burch JM, Moore EE, Moore FA, et al. The abdominal compartment syndrome [J]. Surg Clin North Am, 1996; 76(4)∶833.
15. Moore EE. Staged laparotomy for the hypothermia, acidosis, and coagulopathy syndrome [J].Am J Surg, 1996; 172(5)∶405.
16. Kopelman T, Harris C, Miller R, et al. Abdominal compartment syndrome in patients with isolated extraperitoneal injuries [J]. J Trauma, 2000; 49(4)∶744.
17. Burrows R,Edington J,Robbs JV.A wolf in wolf’s clothing: the abdominal compartment syndrome [J].S Afr Med J,1995; 85(1)∶46.
18. Offner PJ, de Souza AL, Moore EE, et al. Avoidance of abdominal compartment syndrome in damagecontrol laparotomy after trauma [J]. Arch Surg, 2001; 136(6)∶676.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Current Diagnosis and Treatment of Abdominal Compartment Syndrome

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