急性胰腺炎合并腹腔間隔綜合癥英語

CaseReportAbdominalCompartmentSymdrominAPatientwithSevereAcutePancreatitis第1頁，共23頁。AdmissionA56-year-oldmalewasadmittedtoSICUofResearchInstituteofGeneralSurgery,JinlingHospitalon20thOct2003Hesufferdfromepigastricpainfortwodays,dyspneaanddecreasedurineoutput

foroneday

afterafatrichdiet第2頁，共23頁。PEonAdmissionT38℃,HR140bpm,RR30/min,BP82/58mmHgOxygensaturation92%Acutefacewithshortnessofbreath,inagitatedstate,fardistendedabdomenwithhightension,signsofdiffusiveperitonitis,weakbowelsoundsBloodyasciteswasdrawnoutbydiagnosticpunctureUrineoutputdecreasedfurtherandanuriadeveloped第3頁，共23頁。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4頁，共23頁。DiagnosisSevereacutepancreatitisARDSARFShockAbdominalcompartmentsyndrome第5頁，共23頁。TreatmentIntubation,tracheostomy,mechanicalventilationFluidresuscitationandanti-shocktherapyIntraabdominalirrigationbylaparoscopy,continousdrainingbypersistentnegativepressureContinuousvenovenoushighvolumehemofiltrationAnti-acidtherapyandInhibitionofpancreaticsecretionprophylacticantibiotictheray第6頁，共23頁。AdvancementoftheIllnessandOutcomeofthePatient3rdhospitalday,developed“AbdominalCompartmentSyndrome”,andreceivedthe2ndemergentoperationasabdominalopeningandgastrointestinalfistulizationtorelievetheabdominalhighpressure第7頁，共23頁。Intraabdominalpressurewereindirectlymeasuredbybladderpressuremeasurement.第8頁，共23頁。Heexperiencedmassiveabdominalhemorrhagefortwotimes,andeventhe3rdemergentoperationwasperformedforhemostasisandnecrosistissuecleaningVariousmicrobialswererecurrentlyfoundinthecultureofthespecimenofblood,sputum,secretionofwound,thetipsofcentralvenouscatheter,andthefluiddrainedfromtheabdomen

第9頁，共23頁。AdvancementoftheIllnessandOutcomeofthePatient14thday,intestinalfunctionpartiallyrecoveredandTPNwasgraduallyswitchedtoenteralnutrition28thday,CVVHdiscontinued,urineoutputincreasedtomorethan2000ml/d.36thday,mechanicalventilationceasedserumcreatininereturnedtonormalrangeon48thday39thday,and57thday,receivedtwotimesofpostagestampautodermoplastyforskindefectinabdomen161stday,afteraCTscanconfirmingthatpancreaticnecrosisandeffusionwellabsorbed,discharged第10頁，共23頁。腹腔內(nèi)壓力的變化（膀胱測(cè)壓法）第11頁，共23頁。吸入氧濃度和血?dú)獾淖兓?2頁，共23頁。心率的變化第13頁，共23頁。尿量的變化第14頁，共23頁。MAP,HRChangesandDopamine/NoradrenineDoseAdjustment第15頁，共23頁。PaO2/FiO2Changes第16頁，共23頁。UrineOutputandBUN,SCrChangesduringCBPCHVHF(4L/h)CVVH(2L/h)CVVHDiscontinued第17頁，共23頁。SerumelectrolytesChangesduringCHVHFCHVHFday第18頁，共23頁。ArterialpHChangesduringCHVHFArterialpH第19頁，共23頁。ArterialHCO3-andBELevelChangesduringCHVHF第20頁，共23頁。討論此例出現(xiàn)ACS的原因ACS的臨床表現(xiàn)及其對(duì)我們處理的影響ACS的診斷腹腔高壓的處理腹腔開放在ACS處理中的價(jià)值第21頁，共23頁。Thankyou!第22頁，共23頁。內(nèi)容梗概CaseReport。T38℃,HR140bpm,RR30/min,BP82/58mmHg。Oxygensaturation92%。LabExaminationonAd。BUN49mg/dlSCr4.0mg/dl。Abdominalco