外科重症患者合并腹腔间隔室综合征50例诊治分析

目的探讨外科重症(SI)患者合并腹腔间隔室综合征(ACS)的临床治疗方法及疗效。方法选取自2013年11月至2015年1月第二军医大学长征医院急救科收治的50例SI合并ACS患者作为研究对象,分为常规组(n=25)和手术组(n=25),并进行对照分析。常规组接受常规治疗;手术组在常规治疗的基础上,采取手术减压治疗。对比两组患者疗效,并分析SI合并ACS患者预后的独立危险因素。结果常规治疗及手术减压治疗均可使SI合并ACS患者的腹腔压力(IAP)下降,但手术组患者的腹腔灌注压(APP)、残余尿量(RUV)、血乳酸浓度(BLAC)、超敏C反应蛋白(Hs-CRP)及APACHEⅡ评分均显著优于常规(P<0.05);手术组患者的IAP下降幅度比常规组更明显(P<0.05);IAP及CRP可作为判定SI合并ACS患者预后的独立监测因子。结论手术减压治疗SI合并ACS的临床效果显著,而特异性炎症反应是影响SI合并ACS治疗效果及预后的独立危险因素。

A comparative study in surgical intensive patients combined with abdominal interval syndrome:a report in 50 cases

Objective To explore the methods and effect of the treatment of surgical intensive ( SI) patients combined with abdominal interval syndrome( ACS) . Methods Fifty cases of SI patients with ACS were enrolled in this study as research objects and they were randomly divided into regular group(n=25)and surgical group(n=25). Regular group received conventional therapy,scored on the basis of conventional treatment,surgical group was treated with surgical decompression. Curative effects of two groups before and after treatment were compared to determine indicators,and to improve analysis SI merge in patients with ACS independent risk factors of prognosis. Results After routine therapy and surgical decompression,intra-abdominal pressure ( IAP) in SI patients with ACS de-creased. However,the curative effect of SI with ACS evaluation of APP,UR,BLAC,Hs-CRP and APACHE II scores were significantly better than those of the control group(P<0. 05). IAP in observation group of patients decreosed more obvious than the control group (P<0. 05). IAP and CRP can judge SI as merger ACS independent monitoring factors of prognosis after treatment. Conclusion Sur-gical decompression in the treatment of ACS with SI merger effect was remarkable,and the specificity of the inflammatory response was SI with independent risk factors for the development of therapeutic effect and prognosis of ACS.