急性胰腺炎合并腹腔间隔综合症(英语)

CaseReportAbdominalCompartmentSymdrominAPatientwithSevereAcutePancreatitis第一页，共二十三页。AdmissionA56-year-oldmalewasadmittedtoSICUofResearchInstituteofGeneralSurgery,JinlingHospitalon20thOct2003Hesufferdfromepigastricpainfortwodays,dyspneaanddecreasedurineoutput

foroneday

afterafatrichdiet第二页，共二十三页。PEonAdmissionT38℃,HR140bpm,RR30/min,BP82/58mmHgOxygensaturation92%Acutefacewithshortnessofbreath,inagitatedstate,fardistendedabdomenwithhightension,signsofdiffusiveperitonitis,weakbowelsoundsBloodyasciteswasdrawnoutbydiagnosticpunctureUrineoutputdecreasedfurtherandanuriadeveloped第三页，共二十三页。LabExaminationonAdHb18g/dlWBC11300/mm3(N0.88L0.09)Platelet95000/mm3Amy(serum)1270U/LAmy(urine)14819Lipase10003U/LCa1.9mmol/LBUN49mg/dlSCr4.0mg/dlArterialbloodgasanalysis：pH7.26,PaO255mmHg,PaCO228mmHg,BE–14.5mmol/LCT:Diffusivenecrosisofpancreas,massiveascites,leftpleuraleffusion第四页，共二十三页。DiagnosisSevereacutepancreatitisARDSARFShockAbdominalcompartmentsyndrome第五页，共二十三页。TreatmentIntubation,tracheostomy,mechanicalventilationFluidresuscitationandanti-shocktherapyIntraabdominalirrigationbylaparoscopy,continousdrainingbypersistentnegativepressureContinuousvenovenoushighvolumehemofiltrationAnti-acidtherapyandInhibitionofpancreaticsecretionprophylacticantibiotictheray第六页，共二十三页。AdvancementoftheIllnessandOutcomeofthePatient3rdhospitalday,developed“AbdominalCompartmentSyndrome”,andreceivedthe2ndemergentoperationasabdominalopeningandgastrointestinalfistulizationtorelievetheabdominalhighpressure第七页，共二十三页。Intraabdominalpressurewereindirectlymeasuredbybladderpressuremeasurement.第八页，共二十三页。Heexperiencedmassiveabdominalhemorrhagefortwotimes,andeventhe3rdemergentoperationwasperformedforhemostasisandnecrosistissuecleaningVariousmicrobialswererecurrentlyfoundinthecultureofthespecimenofblood,sputum,secretionofwound,thetipsofcentralvenouscatheter,andthefluiddrainedfromtheabdomen

第九页，共二十三页。AdvancementoftheIllnessandOutcomeofthePatient14thday,intestinalfunctionpartiallyrecoveredandTPNwasgraduallyswitchedtoenteralnutrition28thday,CVVHdiscontinued,urineoutputincreasedtomorethan2000ml/d.36thday,mechanicalventilationceasedserumcreatininereturnedtonormalrangeon48thday39thday,and57thday,receivedtwotimesofpostagestampautodermoplastyforskindefectinabdomen161stday,afteraCTscanconfirmingthatpancreaticnecrosisandeffusionwellabsorbed,discharged第十页，共二十三页。腹腔内压力的变化（膀胱测压法）第十一页，共二十三页。吸入氧浓度和血气的变化第十二页，共二十三页。心率的变化第十三页，共二十三页。尿量的变化第十四页，共二十三页。MAP,HRChangesandDopamine/NoradrenineDoseAdjustment第十五页，共二十三页。PaO2/FiO2Changes第十六页，共二十三页。UrineOutputandBUN,SCrChangesduringCBPCHVHF(4L/h)CVVH(2L/h)CVVHDiscontinued第十七页，共二十三页。SerumelectrolytesChangesduringCHVHFCHVHFday第十八页，共二十三页。ArterialpHChangesduringCHVHFArterialpH第十九页，共二十三页。ArterialHCO3-andBELevelChangesduringCHVHF第二十页，共二十三页。讨论此例出现ACS的原因ACS的临床表现及其对我们处理的影响ACS的诊断腹腔高压的处理腹腔开放在ACS处理中的价值第二十一页，共二十三页。Thankyou!第二十二页，共二十三页。内容梗概CaseReport。T38℃,HR140bpm,RR30/min,BP82/58mmHg。Oxygensaturation92%。LabExaminationonAd。Amy(serum)1270U/LAmy(urine)14819Lipase10003U/LCa1.9mmol/L。BUN49mg/dlSCr4.0mg/dl。Abdominal