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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Case Report,Abdominal Compartment Symdrom,in A Patient with Severe Acute Pancreatitis,1,Admission,A 56-year-old male was admitted to SICU of Research Institute of General Surgery, Jinling Hospital on 20th Oct 2003,He sufferd from epigastric,pain,for,two days, dyspnea,and decreased urine output,for,one day,after,a,fat,rich,diet,2,PE on Admission,T 38, HR 140bpm, RR 30/min, BP 82/58mmHg,Oxygen,saturation,92%,Acute face with shortness of breath, in agitated state, far distended abdomen with high tension, signs of diffusive peritonitis, weak bowel sounds,Bloody ascites was drawn out by diagnostic puncture,Urine output decreased further and anuria developed,3,Lab Examination on Ad,Hb 18g/dl WBC 11300/mm3( N0.88 L0.09) P,latelet,95000/mm3,Amy(serum) 1270U/L Amy(urine)14819 Lipase 10003U/L Ca 1.9mmol/L,BUN 49mg/dl SCr 4.0mg/dl,Arterial blood gas analysis：pH 7.26, PaO,2,55mmHg, PaCO,2,28 mmHg, BE 14.5mmol/L,CT: Diffusive necrosis of pancreas, massive ascites, left pleural effusion,4,Diagnosis,Severe acute pancreatitis,ARDS,ARF,Shock,Abdominal compartment syndrome,5,Treatment,Intubation, tracheostomy,mechanical ventilation,Fluid resuscitation and anti-shock therapy,Intraabdominal irrigation by laparoscopy, continous draining by persistent negative pressure,Continuous venovenous high volume hemofiltration,Anti-acid therapy and Inhibition of pancreatic secretion,prophylactic antibiotic theray,6,Advancement of the Illness and Outcome of the Patient,3,rd,hospital day, developed “Abdominal Compartment Syndrome ”, and received the 2,nd,emergent operation as abdominal opening and gastrointestinal fistulization to relieve the abdominal high pressure,7,Intraabdominal pressure were indirectly measured by bladder pressure measurement.,8,He experienced massive abdominal hemorrhage for two times, and even the 3rd emergent operation was performed for,hemostasis,and necrosis tissue cleaning,Various,microbials,were recurrently found in the culture of the specimen of blood, sputum, secretion of wound, the tips of central venous catheter, and the fluid drained from the abdomen,9,Advancement of the Illness and Outcome of the Patient,14th day, intestinal function partially recovered and TPN was gradually switched to enteral nutrition,28,th,day, CVVH discontinued, urine output increased to more than 2000ml/d .,36,th,day, mechanical ventilation ceased,serum creatinine returned to normal range on 48,th,day,39,th,day, and 57th day, received two times of postage stamp autodermoplasty for skin defect in abdomen,161st day, after a CT scan confirming that pancreatic necrosis and effusion well absorbed, discharged,10,腹腔内压力的变化（膀胱测压法）,11,吸入氧浓度和血气的变化,12,心率的变化,13,尿量的变化,14,MAP,HR Changes and Dopamine/Noradrenine Dose Adjustment,15,PaO2/FiO2 Changes,16,Urine Output and BUN, SCr Changes during CBP,CHVHF(4L/h),CVVH(2L/h),CVVH Discontinued,17,Serum electrolytes Changes during CHVHF,CHVHF day,18,Arterial pH Changes during CHVHF,Arterial pH,19,Arterial HCO3- and BE Level Changes during CHVHF,20,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,21,Thank you !,22,
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