早期液体复苏对腹部严重创伤后腹腔间隙综合征的影响

目的探讨早期液体复苏对腹部严重创伤后腹腔间隙综合征的影响。方法 2011年7月~2014年7月,笔者采用膀胱测压法监测70例危重患者腹腔内压,比较常规组和损害控制复苏组(damage control resuscitation,DCR)的每日液体平衡量及累积液体平衡总量。结果与DCR组比较,常规组住院第1、2天液体平衡量显著增加(2 780±690)m L vs(1 728±275)m L,(1 415±1 000)m L vs(910±1 200)m L],两组在第3天液体平衡量无显著差异;常规组的1~3d累积液体平衡量较DCR组均显著增加(2 780±690)m L vs(1 728±275)m L,(4 510±1 149)m L vs(3 250±724)m L,(5 246±1 490)m L vs(4 170±1 926)m L];DCR组的并发症发生率及死亡率均显著低于常规组。结论对腹部严重创伤患者,应积极实施DCR,可有效地减少复苏液体量、降低腹腔高压症/腹腔间隙综合征(IAH/ACS)发生率、缩短住院时间。

Effect of fluid resuscitation on intra-abdominal compartment syndrome in severe abdominal injury patients

Objective To investigate the effect of fluid resuscitation on abdominal compartment syndrome (ACS)in severe abdominal injury patients.Methods Intra-abdominal pressure(IAP)was measured through the bladder manometry in 70 critically ill patients from Jul.2011 to Jul.2014.Daily fluid balance and cumulative fluid balance amounts were compared between the damage control resuscitation(DCR)group and the conventional therapy group.Results The daily fluid balance amount was significantly increased on the 1st,2nd day after admission in the conventional therapy group compared with that of the DCR group:(2 780 ±690) mL vs(1 728 ±275) mL, (1 415 ±1 000)mL vs(910 ±1 200)mL;there was no significant difference in daily fluid balance amount on the 3rd day after admission between the two groups;the cumulative fluid balance amounts were remarkably increased in the conventional therapy group from the 1st to 3rd day after admission than those of the DCR group:(2 780 ±690)mL vs(1 728 ±275)mL,(4 510 ±1 149)mL vs(3 250 ±1 724)mL,(5 246 ±1 490)mL vs(4 170 ±1 926)mL.The mortal-ity and complication of the DCR group were significantly lower than those of the conventional therapy group.Conclusion Severe abdominal injury patients should be treated by DCR actively.DCR can lessen the cumulative fluid balance a-mount,lower the IAH/ACS rate and shorten the hospital stay.