急性胰腺炎合并腹腔间隔综合症英语.ppt

CaseReport,AbdominalCompartmentSymdrominAPatientwithSevereAcutePancreatitis,Admission,A56-year-oldmalewasadmittedtoSICUofResearchInstituteofGeneralSurgery,JinlingHospitalon20thOct2019Hesufferdfromepigastricpainfortwodays,dyspneaanddecreasedurineoutputforonedayafterafatrichdiet,PEonAdmission,T38,HR140bpm,RR30/min,BP82/58mmHgOxygensaturation92%Acutefacewithshortnessofbreath,inagitatedstate,fardistendedabdomenwithhightension,signsofdiffusiveperitonitis,weakbowelsoundsBloodyasciteswasdrawnoutbydiagnosticpunctureUrineoutputdecreasedfurtherandanuriadeveloped,LabExaminationonAd,Hb18g/dlWBC11300/mm3(N0.88L0.09)Platelet95000/mm3Amy(serum)1270U/LAmy(urine)14819Lipase10003U/LCa1.9mmol/LBUN49mg/dlSCr4.0mg/dlArterialbloodgasanalysis：pH7.26,PaO255mmHg,PaCO228mmHg,BE14.5mmol/LCT:Diffusivenecrosisofpancreas,massiveascites,leftpleuraleffusion,Diagnosis,SevereacutepancreatitisARDSARFShockAbdominalcompartmentsyndrome,Treatment,Intubation,tracheostomy,mechanicalventilationFluidresuscitationandanti-shocktherapyIntraabdominalirrigationbylaparoscopy,continousdrainingbypersistentnegativepressureContinuousvenovenoushighvolumehemofiltrationAnti-acidtherapyandInhibitionofpancreaticsecretionprophylacticantibiotictheray,AdvancementoftheIllnessandOutcomeofthePatient,3rdhospitalday,developed“AbdominalCompartmentSyndrome”,andreceivedthe2ndemergentoperationasabdominalopeningandgastrointestinalfistulizationtorelievetheabdominalhighpressure,Intraabdominalpressurewereindirectlymeasuredbybladderpressuremeasurement.,Heexperiencedmassiveabdominalhemorrhagefortwotimes,andeventhe3rdemergentoperationwasperformedforhemostasisandnecrosistissuecleaningVariousmicrobialswererecurrentlyfoundinthecultureofthespecimenofblood,sputum,secretionofwound,thetipsofcentralvenouscatheter,andthefluiddrainedfromtheabdomen,AdvancementoftheIllnessandOutcomeofthePatient,14thday,intestinalfunctionpartiallyrecoveredandTPNwasgraduallyswitchedtoenteralnutrition28thday,CVVHdiscontinued,urineoutputincreasedtomorethan2000ml/d.36thday,mechanicalventilationceasedserumcreatininereturnedtonormalrangeon48thday39thday,and57thday,receivedtwotimesofpostagestampautodermoplastyforskindefectinabdomen161stday,afteraCTscanconfirmingthatpancreaticnecrosisandeffusionwellabsorbed,discharged,腹腔内压力的变化（膀胱测压法）,吸入氧浓度和血气的变化,心率的变化,尿量的变化,MAP,HRChangesandDopamine/NoradrenineDoseAdjustment,PaO2/FiO2Changes,UrineOutputandBUN,SCrChangesduringCBP,CHVHF(4L/h),CVVH(2L/h),CVVHDiscontinued,SerumelectrolytesChangesduringCHVHF,CHVHFday,ArterialpHChangesdur