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Abstract：
Selection of patients for open abdomen (OA) treatment in severe acute pancreatitis (SAP) is challenging. Treatment related morbidity and risk of adverse events are high; however, refractory abdominal compartment syndrome (ACS) is potentially lethal. Factors influencing the decision to initiate OA treatment are clinically important. We aimed to study these factors to help understand what influences the selection of patients for OA treatment in SAP.
A single center study of patients with SAP that underwent OA treatment compared with conservatively treated matched controls.
Within study period, 47 patients treated with OA were matched in a 1:1 fashion with conservatively treated control patients. Urinary output under 20 ml/h (OR 5.0 95% CI 1.8-13.7) and ACS (OR 4.6 95% CI 1.4-15.2) independently associated with OA treatment. Patients with OA treatment had significantly more often visceral ischemia (34%) than controls (6%), P = 0.002. Mortality among patients with visceral ischemia was 63%. Clinically meaningful parameters predicting developing ischemia were not found. OA treatment associated with higher overall 90-day mortality rate (43% vs 17%, P = 0.012) and increased need for necrosectomy (55% vs 21%, P = 0.001). Delayed primary fascial closure was achieved in 33 (97%) patients that survived past OA treatment.
Decreased urine output and ACS were independently associated with the choice of OA treatment in patients with SAP. Underlying visceral ischemia was strikingly common in patients undergoing OA treatment, but predicting ischemia in these patients seems difficult.
A single center study of patients with SAP that underwent OA treatment compared with conservatively treated matched controls.
Within study period, 47 patients treated with OA were matched in a 1:1 fashion with conservatively treated control patients. Urinary output under 20 ml/h (OR 5.0 95% CI 1.8-13.7) and ACS (OR 4.6 95% CI 1.4-15.2) independently associated with OA treatment. Patients with OA treatment had significantly more often visceral ischemia (34%) than controls (6%), P = 0.002. Mortality among patients with visceral ischemia was 63%. Clinically meaningful parameters predicting developing ischemia were not found. OA treatment associated with higher overall 90-day mortality rate (43% vs 17%, P = 0.012) and increased need for necrosectomy (55% vs 21%, P = 0.001). Delayed primary fascial closure was achieved in 33 (97%) patients that survived past OA treatment.
Decreased urine output and ACS were independently associated with the choice of OA treatment in patients with SAP. Underlying visceral ischemia was strikingly common in patients undergoing OA treatment, but predicting ischemia in these patients seems difficult.
摘要：
在重症急性胰腺炎（SAP）中选择开腹（OA）治疗的患者具有挑战性。治疗相关的发病率和不良事件的风险很高;然而，难治性腹腔室综合征（ACS）具有潜在的致命性。影响开始OA治疗的决定的因素在临床上很重要。我们旨在研究这些因素，以帮助了解什么影响SAP中OA治疗患者的选择。
一项单中心研究，对接受OA治疗的SAP患者与保守治疗的匹配对照进行比较。
在学习期间，47例接受OA治疗的患者与保守治疗的对照患者以1：1的方式匹配。20ml/h下的尿量（OR5.095％CI1.8-13.7）和ACS（OR4.695％CI1.4-15.2）与OA治疗独立相关。接受OA治疗的患者内脏缺血（34%）明显多于对照组（6%），P=0.002。内脏缺血患者的死亡率为63%。没有发现预测发生缺血的临床意义的参数。OA治疗与较高的总体90天死亡率相关（43％vs17％，P=0.012）和坏死切除术的需求增加（55%vs21%，P=0.001)。33例（97％）在OA治疗后存活的患者中实现了延迟的原发性筋膜闭合。
尿量减少和ACS与SAP患者OA治疗的选择独立相关。在接受OA治疗的患者中，潜在的内脏缺血非常常见，但是预测这些患者的缺血似乎很困难。
一项单中心研究，对接受OA治疗的SAP患者与保守治疗的匹配对照进行比较。
在学习期间，47例接受OA治疗的患者与保守治疗的对照患者以1：1的方式匹配。20ml/h下的尿量（OR5.095％CI1.8-13.7）和ACS（OR4.695％CI1.4-15.2）与OA治疗独立相关。接受OA治疗的患者内脏缺血（34%）明显多于对照组（6%），P=0.002。内脏缺血患者的死亡率为63%。没有发现预测发生缺血的临床意义的参数。OA治疗与较高的总体90天死亡率相关（43％vs17％，P=0.012）和坏死切除术的需求增加（55%vs21%，P=0.001)。33例（97％）在OA治疗后存活的患者中实现了延迟的原发性筋膜闭合。
尿量减少和ACS与SAP患者OA治疗的选择独立相关。在接受OA治疗的患者中，潜在的内脏缺血非常常见，但是预测这些患者的缺血似乎很困难。
