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目的:回顾重症急性胰腺炎(SAP)病人合并腹腔间室综合征(ACS)接受腹腔开放术后器官功能的变化及临床结局,分析腹腔开放治疗对病人预后的影响和存在的问题。方法:收集SAP合并ACS并且接受腹腔开放减压的病人10例。记录腹腔开放前后血流动力学参数、器官功能指标和病人的临床结局。结果:本研究共纳入10例病人,平均年龄为(47±13)岁,胆源性胰腺炎为主要患病原因(6/10)。行腹腔开放减压术的具体原因分别为血流动力学紊乱5例,呼吸功能衰竭3例,肾功能衰竭1例,腹腔出血1例。腹腔开放减压后腹腔压力(IAP)明显下降[(30.4±3.062)mm Hg vs(14.5±1.179)mm Hg,P<0.05)],但血流动力学和器官功能指标变化趋势各异。10例病人中死亡5例,病死率为50%。结论:腹腔开放减压可明显降低SAP合并ACS病人的IAP,但仍会导致继发性器官功能损害,影响ACS病人的预后。
OBJECTIVE: To review the changes of organ function and clinical outcome in patients with severe acute pancreatitis (SAP) complicated with peritoneal compartment syndrome (ACS) receiving open abdominal surgery and analyze the influence of open abdominal treatment on prognosis and existing problems. Methods: Ten patients with SAP complicated with ACS and undergoing open abdominal decompression were collected. The hemodynamic parameters, organ function and patient’s clinical outcome before and after abdominal opening were recorded. Results: A total of 10 patients were enrolled in this study, with an average age of (47 ± 13) years. Gallbladder pancreatitis was the main cause of illness (6/10). Specific open abdominal decompression surgery were hemodynamic disorders in 5 cases, respiratory failure in 3 cases, 1 case of renal failure, abdominal bleeding in 1 case. Intraperitoneal pressure (IAP) decreased significantly after open decompression [(30.4 ± 3.062) mm Hg vs (14.5 ± 1.179) mm Hg, P <0.05) .However, the trend of hemodynamics and organ function varied. Five patients died in 10 patients, with a mortality rate of 50%. Conclusions: Open abdominal decompression can significantly reduce IAP in SAP patients with SAP, but still lead to secondary organ dysfunction and affect the prognosis of patients with ACS.