开腹减压术已被建议作为在医疗管理失败时治疗腹腔室综合征(ACS)的潜在治疗方法;然而,在已发表的文献中,对器官功能参数的影响明显不同。在这项研究中,我们试图研究开腹减压术对危重成人和儿科ACS患者腹内压和器官功能的影响。特别关注血液动力学,呼吸,肾功能和结果。
对文献进行了系统评价和荟萃分析。报道腹内压(IAP)数据的文章,血液动力学(平均动脉压[MAP],中心静脉压[CVP],心脏指数[CI],心率[HR],全身血管阻力指数[SVRI]和/或肺毛细血管楔压[PCWP]),呼吸(呼气末正压[PEEP],峰值吸气压力[PIP]和/或动脉氧分压与吸入氧分压之比[P/F比]),分析了开腹减压术后的尿量(UO)。
共纳入15篇文章;3篇仅包括儿童(18岁或以下)。在纳入的286名患者中,49.7%患有原发性ACS。减压后,成人的基线平均IAP平均下降,平均为18.2±6.5mmHg,从31.7±6.4mmHg到13.5±3.0mmHg。HR下降(12.2±9.5次/分钟;p=0.04),CVP(4.6±2.3mmHg;p=0.022),PCWP(5.8±2.3mmHg;p=0.029),和PIP(10.1±3.9cmH2O;p<0.001),P/F比平均增加(70.4±49.4;p<0.001)和UO(95.3±105.3ml/h;p<0.001)。在儿童中,MAP明显增加(20.0±2.3mmHg;p=0.006),市盈率(238.2;p<0.001),和UO(2.88±0.64ml/kg/h;p<0.001),CVP(7mmHg;p=0.016)和PIP(9.9cmH2O;p=0.002)降低。开腹减压术后成人总死亡率为49.7%,儿童总死亡率为60.8%。
开腹减压术导致IAP明显降低,对血液动力学有有益的影响,呼吸,和肾脏参数。在成人和儿童中,剖腹减压手术后的死亡率仍然很高。
Decompressive laparotomy has been advised as potential treatment for abdominal compartment syndrome (ACS) when medical management fails; yet, the effect on parameters of organ function differs markedly in the published literature. In this study, we sought to investigate the effect of decompressive laparotomy on intra-abdominal pressure and organ function in critically ill adult and pediatric patients with ACS, specifically focusing on hemodynamic, respiratory, and kidney function and outcome.
A systematic review and meta-analysis of the literature was performed. Articles reporting data on intra-abdominal pressure (IAP), hemodynamic (mean arterial pressures [MAP], central venous pressure [CVP], cardiac index [CI], heart rate [HR], systemic vascular resistance index [SVRI] and/or pulmonary capillary wedge pressure [PCWP]), respiratory (positive end-expiratory pressure [PEEP], peak inspiratory pressure [PIP] and/or ratio of partial pressure arterial oxygen and fraction of inspired oxygen [P/F ratio]), and/or urinary output (UO) following decompressive laparotomy were analyzed.
A total of 15 articles were included; 3 included children only (aged 18 years or younger). Of the 286 patients who were included, 49.7% had primary ACS. The baseline mean IAP in adults decreased with an average of 18.2 ± 6.5 mmHg following decompression, from 31.7 ± 6.4 mmHg to 13.5 ± 3.0 mmHg. There was a decrease in HR (12.2 ± 9.5 beats/min; p = 0.04), CVP (4.6 ± 2.3 mmHg; p = 0.022), PCWP (5.8 ± 2.3 mmHg; p = 0.029), and PIP (10.1 ± 3.9 cmH2O; p < 0.001) and a mean increase in P/F ratio (70.4 ± 49.4; p < 0.001) and UO (95.3 ± 105.3 ml/h; p < 0.001). In children, there was a significant increase in MAP (20.0 ± 2.3 mmHg; p = 0.006), P/F ratio (238.2; p < 0.001), and UO (2.88 ± 0.64 ml/kg/h; p < 0.001) and a decrease in CVP (7 mmHg; p = 0.016) and PIP (9.9 cmH2O; p = 0.002). The overall mortality rate was 49.7% in adults and 60.8% in children following decompressive laparotomy.
Decompressive laparotomy resulted in a significantly lower IAP and had beneficial effects on hemodynamic, respiratory, and renal parameters. Mortality after decompressive laparotomy remains high in both adults and children.