• 四川大學(xué)華西醫(yī)院中西醫(yī)結(jié)合科（成都，610041）;

【摘要】　 在重癥急性胰腺炎（severe acute pancreatitis，SAP）發(fā)生時(shí)，能及時(shí)認(rèn)識(shí)并診斷腹內(nèi)高壓（intra abdominal hypertension，IAH）甚至腹腔室隔綜合征（abdominal compartment syndrome，ACS），并給予及時(shí)的治療有可能逆轉(zhuǎn)其帶來(lái)的進(jìn)一步的病理生理?yè)p害。因此，認(rèn)識(shí)并了解IAH和ACS的發(fā)病機(jī)制、特征、診斷與治療進(jìn)展在SAP的治療中有重要意義，現(xiàn)就上述方面進(jìn)行綜述。

引用本文： 萬(wàn)美華,唐文富,夏慶. 重癥急性胰腺炎與腹腔室隔綜合征的研究進(jìn)展. 華西醫(yī)學(xué), 2011, 26(9): 1420-1423. doi: 復(fù)制

1. 　De Waele JJ, De Laet I, Kirkpatrick AW, et al. Intra-abdominal hypertension and abdominal compartment syndrome [J]. Am J Kidney Dis, 2011, 57(1): 159-169.
2. 　De Waele JJ, Hesse UJ. Life saving abdominal decompression in a patient with severe acute pancreatitis [J]. Acta Chir Belg, 2005, 105 (1): 96-98.
3. 　Sugrue M, Jones F, Deane SA, et al. Intra-abdominal hypertension is an independent cause of postoperative renal impairment [J]. Arch Surg, 1999, 134(10): 1082-1085.
4. 　Al-Bahrani AZ, Darwish A, Hamza N, et al. Gut barrier dysfunction in critically ill surgical patients with abdominal compartment syndrome [J]. Pancreas, 2010, 39(7): 1064-1069.
5. 　De Waele JJ, Hoste E, Blot SI, et al. Intra-abdominal hypertension in patients with severe acute pancreatitis [J]. Crit Care, 2005, 9(4): 452-457.
6. 　Sanchez NC, Tenofsky PL, Dort JM, et al. What is normal intra-abdominal pressure? [J]. Am Surg, 2001, 67(3): 243-248.
7. 　Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration [J]. Ann Surg, 1983, 199(1): 28-33.
8. 　World Society of Abdominal Compartment Syndrome Consensus Conference Definitions. In: Inaugural World Congress-Abdominal Compartment Syndrome. 2004.
9. 　Malbrain ML, De laet I, Cheatham M. Consensus conference definitions and recommendations on intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) - the long road to the final publications, how did we get there? [J]. Acta Clin Belg, 2007(Suppl 1): 44-59.
10. 　Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions [J]. Intensive Care Med, 2006, 32: 1722-1732.
11. 　Dambrauskas Z, Parseliunas A, Gulbinas A, et al. Early recognition of abdominal compartment syndrome in patients with acute pancreatitis [J]. World J Gastroenterol, 2009, 15(6):717-721.
12. 　Marx G, Vangerow B, Burczyk C, et al. Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients[J]. Intensive Care Med, 2000, 26 (9): 1252-1258.
13. 　Rezende-Neto JB, Moore EE, Melo de Andrade MV, et al. Systemic inflammatory response secondary to abdominal compartment syndrome: stage for multiple organ failure [J]. J Trauma, 2002, 53(6): 1121-1128.
14. 　De Waele JJ, Hesse UJ. Life saving abdominal decompression in a patient with severe acute pancreatitis [J]. Acta Chir Belg, 2005, 105(1): 96-98.
15. 　Mao EQ, Tang YQ, Fei J, et al. Fluid therapy for severe acute pancreatitis in acute response stage [J]. Chin Med J (Engl), 2009, 122(2): 169-173.
16. 　Zhang WF, Ni YL, Cai L, et al. Intraabdominal pressure monitoring in predicting outcome of patients with severe acute pancreatitis[J]. Hepatobiliary Pancreat Dis Int, 2007, 6(4): 420-423.
17. 　Chang MC, Miller PR, D’Agostino R Jr, et al. Effects of abdominal decompression on cardiopulmonary function and visceral perfusion in patients with intra-abdominal hypertension [J]. J Trauma, 1998, 44(3): 440-445.
18. 　Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance [J]. Arch Surg, 1995, 130(5): 544-548.
19. 　Sugerman HJ, Bloomfield GL, Saggi BW. Multisystem organ failure secondary to increased intraabdominal pressure [J]. Infection, 1999, 27(1): 61-66.
20. 　Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on msenteric arterial and intestinal mucosal blood-flow [J]. J Trauma, 1992, 33(1): 45-49.
21. 　Chiu CJ, McArdle AH, Brown R, et al. Intestinal mucosal lesion in low-flow states [J]. Arch Surg, 1970, 101(4): 478-483.
22. 　Parks DA, Bulkley GB, Granger DN, et al. Ischemic injury in the cat small intestine: role of superoxide radicals [J]. Gastroenterology, 1982, 82(1): 9-15.
23. 　Malbrain ML. Is it wise not to think about intraabdonimal hypertention in the ICU [J]. Curr Opin Crit Care, 2004, 10(2): 232-245.
24. 　De Waele JJ, Leppäniemi AK. Intra-abdominal hypertension in acute pancreatitis [J]. World J Surg, 2009, 33(6): 1128-1133.
25. 　De Waele JJ, Hoste E, Blot SI, et al. Intra-abdominal hypertension in patients with severe acute pancreatitis[J]. Crit Care, 2005, 9(4): 452-457.
26. 　Keskinen P, Leppaniemi A, Pettila V, et al. Intra-abdominal pressure in severe acute pancreatitis [J].World J Emerg Surg, 2007, 2(1): 2-9.
27. 　Caronna R, Benedetti M, Morelli A, et al. Clinical effects of laparotomy with perioperative continuous peritoneal lavage and postoperative hemofiltration in patients with severe acute pancreatitis [J]. World J Emerg Surg, 2009, 4: 45-51.
28. 　Oda S, Hirasawa H, Shiga H, et al. Management of intra-abdominal hypertension in patients with severe acute pancreatitis with continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter [J]. Ther Apher Dial, 2005, 9(4): 355-361.
29. 　Sun ZX, Huang HR, Zhou H. Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis [J]. World J Gastroenterol, 2006, 12(31): 5068-5070.
30. 　Hobson KG, Young KM, Ciraulo A, et al. Release of abdominal compartment syndrome improves survival in patients with burn injuries [J]. J Trauma, 2002, 53(6): 1129-1134.
31. 　Siebig S, Iesalnieks I, Bruennler T, et al. Recovery from respiratory failure after decompression laparotomy for severe acute pancreatitis [J]. World J Gastroenterol, 2008, 14(35): 5467-5470.
32. 　Cheatham ML, Safcsak K, Llerena LE, et al. Long-term physical, mental, and functional consequences of abdominal decompression [J]. J Trauma, 2004, 56(2): 237-242.
33. 　夏慶, 蔣俊明, 龔旭, 等. 通下法抗急性壞死性胰腺炎肺損害的實(shí)驗(yàn)研究[J]. 中國(guó)中西醫(yī)結(jié)合外科雜志, 1997, 3(5): 336-339.
34. 　蔣俊明, 張瑞明, 黃宗文, 等. 益活清下法治療重癥急性胰腺炎[J]. 中國(guó)中西醫(yī)結(jié)合外科雜志, 1995, 1(1): 13-15.
35. 　Zhang MJ, Zhang GL, Yuan WB, et al. Treatment of abdominal compartment syndrome in severe acute pancreatitis patients with traditional Chinese medicine [J]. World J Gastroenterol, 2008, 14(22): 3574-3578.
36. 　Tang WF, Yu Q, Wan MH, et al. Simultaneous determination and pharmacokinetic studies of aloe emodin and chrysophanol in rats after oral administration of Da-Cheng-Qi decoction by high-performance liquid chromatography[J]. Biomed Chromatogr, 2007, 21(7): 701-707.
37. 　黃宗文, 夏慶, 陳光遠(yuǎn), 等. 早期應(yīng)用柴芩承氣湯治療重癥急性胰腺炎臨床療效分析[J]. 成都中醫(yī)藥大學(xué)學(xué)報(bào), 2003, 26(3): 25-26.
38. 　謝基良, 張志堯, 吳咸中. 承氣方劑對(duì)腸屏障功能保護(hù)作用的實(shí)驗(yàn)研究[J]. 中國(guó)中西醫(yī)結(jié)合外科雜志, 2002, 8(3): 189-191.
39. 　馮立民, 陳海龍, 關(guān)鳳林. 陽(yáng)明腑實(shí)證時(shí)內(nèi)毒素與炎癥介質(zhì)的變化及復(fù)方大承氣湯的治療作用[J]. 中國(guó)中西醫(yī)結(jié)合外科雜志, 2003, 9(5): 351-353.
40. 　趙霧卿, 劉曉紅. 大黃對(duì)急性胰腺炎多靶點(diǎn)的治療作用[J]. Chin J Gastroenterol, 2003, 8(5): 316-617.
41. 　馬曉春. 清胰解毒湯治療重癥急性胰腺炎的臨床研究[J]. 中國(guó)中西醫(yī)結(jié)合消化雜志, 2002, 10(4): 223-224.
42. 　李志新, 邱錦芳, 張忠. 通腑攻下法治療重癥急性胰腺炎合并腹腔間隔室綜合征臨床體會(huì)[J]. 新中醫(yī), 2004, 36 (10) : 33-34.
43. 　張贅華, 酈岳. 大承氣湯治療腹腔間隔室綜合征療效觀察[J]. 浙江中西醫(yī)結(jié)合雜志, 2007, 17 (10): 612-613.
44. 　Joynt GM, Gomersall CD. Intra-abdominal hypertension-an intensive care perspective[J]. Crit Care Shock, 2003, 6(3): 131-138.
  1. 1. 　De Waele JJ, De Laet I, Kirkpatrick AW, et al. Intra-abdominal hypertension and abdominal compartment syndrome [J]. Am J Kidney Dis, 2011, 57(1): 159-169.
  2. 2. 　De Waele JJ, Hesse UJ. Life saving abdominal decompression in a patient with severe acute pancreatitis [J]. Acta Chir Belg, 2005, 105 (1): 96-98.
  3. 3. 　Sugrue M, Jones F, Deane SA, et al. Intra-abdominal hypertension is an independent cause of postoperative renal impairment [J]. Arch Surg, 1999, 134(10): 1082-1085.
  4. 4. 　Al-Bahrani AZ, Darwish A, Hamza N, et al. Gut barrier dysfunction in critically ill surgical patients with abdominal compartment syndrome [J]. Pancreas, 2010, 39(7): 1064-1069.
  5. 5. 　De Waele JJ, Hoste E, Blot SI, et al. Intra-abdominal hypertension in patients with severe acute pancreatitis [J]. Crit Care, 2005, 9(4): 452-457.
  6. 6. 　Sanchez NC, Tenofsky PL, Dort JM, et al. What is normal intra-abdominal pressure? [J]. Am Surg, 2001, 67(3): 243-248.
  7. 7. 　Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration [J]. Ann Surg, 1983, 199(1): 28-33.
  8. 8. 　World Society of Abdominal Compartment Syndrome Consensus Conference Definitions. In: Inaugural World Congress-Abdominal Compartment Syndrome. 2004.
  9. 9. 　Malbrain ML, De laet I, Cheatham M. Consensus conference definitions and recommendations on intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) - the long road to the final publications, how did we get there? [J]. Acta Clin Belg, 2007(Suppl 1): 44-59.
  10. 10. 　Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions [J]. Intensive Care Med, 2006, 32: 1722-1732.
  11. 11. 　Dambrauskas Z, Parseliunas A, Gulbinas A, et al. Early recognition of abdominal compartment syndrome in patients with acute pancreatitis [J]. World J Gastroenterol, 2009, 15(6):717-721.
  12. 12. 　Marx G, Vangerow B, Burczyk C, et al. Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients[J]. Intensive Care Med, 2000, 26 (9): 1252-1258.
  13. 13. 　Rezende-Neto JB, Moore EE, Melo de Andrade MV, et al. Systemic inflammatory response secondary to abdominal compartment syndrome: stage for multiple organ failure [J]. J Trauma, 2002, 53(6): 1121-1128.
  14. 14. 　De Waele JJ, Hesse UJ. Life saving abdominal decompression in a patient with severe acute pancreatitis [J]. Acta Chir Belg, 2005, 105(1): 96-98.
  15. 15. 　Mao EQ, Tang YQ, Fei J, et al. Fluid therapy for severe acute pancreatitis in acute response stage [J]. Chin Med J (Engl), 2009, 122(2): 169-173.
  16. 16. 　Zhang WF, Ni YL, Cai L, et al. Intraabdominal pressure monitoring in predicting outcome of patients with severe acute pancreatitis[J]. Hepatobiliary Pancreat Dis Int, 2007, 6(4): 420-423.
  17. 17. 　Chang MC, Miller PR, D’Agostino R Jr, et al. Effects of abdominal decompression on cardiopulmonary function and visceral perfusion in patients with intra-abdominal hypertension [J]. J Trauma, 1998, 44(3): 440-445.
  18. 18. 　Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance [J]. Arch Surg, 1995, 130(5): 544-548.
  19. 19. 　Sugerman HJ, Bloomfield GL, Saggi BW. Multisystem organ failure secondary to increased intraabdominal pressure [J]. Infection, 1999, 27(1): 61-66.
  20. 20. 　Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on msenteric arterial and intestinal mucosal blood-flow [J]. J Trauma, 1992, 33(1): 45-49.
  21. 21. 　Chiu CJ, McArdle AH, Brown R, et al. Intestinal mucosal lesion in low-flow states [J]. Arch Surg, 1970, 101(4): 478-483.
  22. 22. 　Parks DA, Bulkley GB, Granger DN, et al. Ischemic injury in the cat small intestine: role of superoxide radicals [J]. Gastroenterology, 1982, 82(1): 9-15.
  23. 23. 　Malbrain ML. Is it wise not to think about intraabdonimal hypertention in the ICU [J]. Curr Opin Crit Care, 2004, 10(2): 232-245.
  24. 24. 　De Waele JJ, Leppäniemi AK. Intra-abdominal hypertension in acute pancreatitis [J]. World J Surg, 2009, 33(6): 1128-1133.
  25. 25. 　De Waele JJ, Hoste E, Blot SI, et al. Intra-abdominal hypertension in patients with severe acute pancreatitis[J]. Crit Care, 2005, 9(4): 452-457.
  26. 26. 　Keskinen P, Leppaniemi A, Pettila V, et al. Intra-abdominal pressure in severe acute pancreatitis [J].World J Emerg Surg, 2007, 2(1): 2-9.
  27. 27. 　Caronna R, Benedetti M, Morelli A, et al. Clinical effects of laparotomy with perioperative continuous peritoneal lavage and postoperative hemofiltration in patients with severe acute pancreatitis [J]. World J Emerg Surg, 2009, 4: 45-51.
  28. 28. 　Oda S, Hirasawa H, Shiga H, et al. Management of intra-abdominal hypertension in patients with severe acute pancreatitis with continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter [J]. Ther Apher Dial, 2005, 9(4): 355-361.
  29. 29. 　Sun ZX, Huang HR, Zhou H. Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis [J]. World J Gastroenterol, 2006, 12(31): 5068-5070.
  30. 30. 　Hobson KG, Young KM, Ciraulo A, et al. Release of abdominal compartment syndrome improves survival in patients with burn injuries [J]. J Trauma, 2002, 53(6): 1129-1134.
  31. 31. 　Siebig S, Iesalnieks I, Bruennler T, et al. Recovery from respiratory failure after decompression laparotomy for severe acute pancreatitis [J]. World J Gastroenterol, 2008, 14(35): 5467-5470.
  32. 32. 　Cheatham ML, Safcsak K, Llerena LE, et al. Long-term physical, mental, and functional consequences of abdominal decompression [J]. J Trauma, 2004, 56(2): 237-242.
  33. 33. 　夏慶, 蔣俊明, 龔旭, 等. 通下法抗急性壞死性胰腺炎肺損害的實(shí)驗(yàn)研究[J]. 中國(guó)中西醫(yī)結(jié)合外科雜志, 1997, 3(5): 336-339.
  34. 34. 　蔣俊明, 張瑞明, 黃宗文, 等. 益活清下法治療重癥急性胰腺炎[J]. 中國(guó)中西醫(yī)結(jié)合外科雜志, 1995, 1(1): 13-15.
  35. 35. 　Zhang MJ, Zhang GL, Yuan WB, et al. Treatment of abdominal compartment syndrome in severe acute pancreatitis patients with traditional Chinese medicine [J]. World J Gastroenterol, 2008, 14(22): 3574-3578.
  36. 36. 　Tang WF, Yu Q, Wan MH, et al. Simultaneous determination and pharmacokinetic studies of aloe emodin and chrysophanol in rats after oral administration of Da-Cheng-Qi decoction by high-performance liquid chromatography[J]. Biomed Chromatogr, 2007, 21(7): 701-707.
  37. 37. 　黃宗文, 夏慶, 陳光遠(yuǎn), 等. 早期應(yīng)用柴芩承氣湯治療重癥急性胰腺炎臨床療效分析[J]. 成都中醫(yī)藥大學(xué)學(xué)報(bào), 2003, 26(3): 25-26.
  38. 38. 　謝基良, 張志堯, 吳咸中. 承氣方劑對(duì)腸屏障功能保護(hù)作用的實(shí)驗(yàn)研究[J]. 中國(guó)中西醫(yī)結(jié)合外科雜志, 2002, 8(3): 189-191.
  39. 39. 　馮立民, 陳海龍, 關(guān)鳳林. 陽(yáng)明腑實(shí)證時(shí)內(nèi)毒素與炎癥介質(zhì)的變化及復(fù)方大承氣湯的治療作用[J]. 中國(guó)中西醫(yī)結(jié)合外科雜志, 2003, 9(5): 351-353.
  40. 40. 　趙霧卿, 劉曉紅. 大黃對(duì)急性胰腺炎多靶點(diǎn)的治療作用[J]. Chin J Gastroenterol, 2003, 8(5): 316-617.
  41. 41. 　馬曉春. 清胰解毒湯治療重癥急性胰腺炎的臨床研究[J]. 中國(guó)中西醫(yī)結(jié)合消化雜志, 2002, 10(4): 223-224.
  42. 42. 　李志新, 邱錦芳, 張忠. 通腑攻下法治療重癥急性胰腺炎合并腹腔間隔室綜合征臨床體會(huì)[J]. 新中醫(yī), 2004, 36 (10) : 33-34.
  43. 43. 　張贅華, 酈岳. 大承氣湯治療腹腔間隔室綜合征療效觀察[J]. 浙江中西醫(yī)結(jié)合雜志, 2007, 17 (10): 612-613.
  44. 44. 　Joynt GM, Gomersall CD. Intra-abdominal hypertension-an intensive care perspective[J]. Crit Care Shock, 2003, 6(3): 131-138.