肝移植术后腹腔间隙综合征的诊治体会

目的 总结肝移植术后腹腔间隙综合征(ACS)的诊治体会。方法 采用膀胱内压检测法间接测量腹内压(IAP)，监测术后心、肺、肾功能。术后IAP大于20mmHg，同时有一项或多项器官功能受损诊断为ACS。合理补液，采用腹腔内重新置管引流、腹腔穿刺、肌松药等非开腹减压方法以治疗ACS。结果 9例ACS患者中，6例出现急性肾功能损害，其中4例表现为少尿或无尿；6例出现低氧血症，机械通气时间延长；4例心率明显增快，其中3例并发心衰。除2例死于多器官功能不全综合征外，7例患者经上述治疗后腹胀显著减轻，心肺肾功能恢复正常。结论 肝移植术后加强对ACS的重视、术后早期IAP的严密监测以及尽早的非开腹减压治疗具有较重要的临床意义。

THE DIAGNOSIS AND TREATMENT OF ABDOMINAL COMPARTMENT SYNDROME AFTER LIVER TRANSPLANTATION (REPORT OF NINE CASES)

Objective To summarize experience in diagnosis and treatment of abdominal compartment syndrome(ACS) after liver transplantation in nine cases.Methods Measuring intra-abdominal pressure(IAP) by intravesical pressure.Monitoring Cardiac,puimonary and renal function after liver transplantation.ACS is diagnosised when IAP greater than 20mmHg complicated by at least one organ dysfunction or filure.Decompressing the abdomen by reasonable fluid replacement,intra-abdominal drainage-tube reputed in,abdominal paracentesis and muscle relaxant.Result Six cases present acute renal impairment,six cases have hypoxemia,three cases present congestive heart failure.Two cases died of multiple organ dysfunction syndrome,but seven cases was restored completely.Conclusion Patients undergoing liver transplantation are at risk of ACS,it is worth monitoring IAP in the liver transplant recipients during the postoperative early period, abdominal decompession by no-relaparotomy can restore organ fuction being impaired and have good outcomes.