急性重症胰腺炎并发腹腔室隔综合征的分型及其临床意义

目的：初步探讨重症胰腺炎并发腹腔室隔综合征（ACS）的不同类型及其对临床治疗的意义。方法：结合典型病例，提出重症胰腺炎并发腹腔室隔综合征不同类型，并对每种类型的临床特征、处理方法进行总结。结果：Ⅰ型腹腔室隔综合征（胃肠型）以胃肠道功能障碍、胃肠大量气液积聚为特征，主要影响呼吸功能；Ⅱ型（腹膜后型）以腹膜后大量渗出或组织坏死为特征，其中早期型以组织坏死为主，迟发型以液体积聚为特征，主要影响心、肾功能。临床和CT动态观察可以明确ACS类型和严重程度。Ⅰ型ACS治疗以积极处理原发病、纠正水电解质酸碱失衡、胃肠减压、导泻为治疗原则；Ⅱ型ACS应选择适当的手术减压时机，其中早发型手术并发症多，而迟发型手术效果较好。结论：明确重症胰腺炎并发ACS类型，针对不同类型ACS选择不同治疗手段有助于提高疗效、减少并发症、缩短住院时间和降低诊疗费用.

Abdmninal compartment syndrome complicating with severe cutepancreatitis

Objective:To investigate different types abdominalcompartment syndrome(ACS)complicating with severe acute pancreatitis(SAP).Methods:The clinical features and therapeutic principles of 2 types of ACS complicating with SAP weresummarized in 3 typical cases.Results:Type I ACS(gut type)was mainly caused by gastroin-testinaldysfunction.with gastrointestinal gas or liquid accumulation,chiefly ffecting respiratoryfunction.Type II ACS(retro-peritoneal type)was mainly caused by retro-peritoneal necrosis orexudation.chiefly affecting cardiovascular and renal function.Observation of clinical manifestationsand CT scanning could obtain differential diagnosis.Type I ACS could effectively be treated with liquid,electrical and gut balancing while type II ACS needed prompt decompression.Conclusion:Different types of ACS complicating with SAP have different clinical features and need different treatments.Summarizing different types of ACS complicating with SAP may improve the understanding and therapy of this pathophysiological procedure.