腹腔间隙综合征中文_ppt课件.ppt

IAH/ACS Management: Paralysis De Waele, Crit Care Med 2003 UOP IAP IAH/ACS Management: Colloids O’Mara, 2005: Prospective randomized evaluation of IAP with crystalloid and colloid resuscitation in burns 31 cases with 25% burn plus inhalation or 40% burn without inhalation Randomized to saline vs plasma Results post resuscitation: Crystalloid IAP mean 26.5 mm Hg Plasma IAP mean 10.6 mm Hg IAH/ACS Management: Hemofiltration Oda, 2005: Management of IAH in patients with severe acute pancreatitis using continuous hemofiltration. 17 cases of severe pancreatitis and IAH Treated with hemofiltration when IAP + 15 mm, PRIOR to developing renal insufficiency (maintained adequate serum oncotic pressure with albumin) Results: Interleukin (IL-6) cytokine levels cut in half Reduced vascular permeability and interstitial edema Mean IAP value dropped from 15 mm to less than 10 mm 16 of 17 patients discharged alive without complication IAH/ACS Management: Paracentesis Multiple case series reporting successful treatment of IAH and ACS: Latenser 2002: Burn patient management Reckard 2005: Peripancreatic fluid filled mass Sharp 2002: Pediatric blunt trauma Etzion 2004: Malignant ascites therapy Sun 2006: Pancreatitis (prospective RCT) Cut deaths in half, cut hospital LOS by 13 days IAH/ACS Management Decompressive Laparotomy: Err on the side of early vs late intervention Less bowel edema or cell damage, better chance of early closure and early recovery. Be aware that delaying care until this complication occurs is VERY expensive – more expensive the longer you wait: Vanderbilt costs for open abdomen (Vogel 2007): Same admission closure - $150,000 Failure to close on initial admission $250,000 (estimate nearly as much over next year by time ventral hernia finally repaired). IAH/ACS Management: Decompressive Laparotomy Rigid Abdomen in ACS Post decompressive laparotomy Decompressive Laparotomy Delay in abdominal decompression may lead to intestinal ischemia Decompress Early! D