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Hepatoma Research 2016年第1期2卷 287-292页

作者： Li Lei Camilla J.Cobb Jeffrey Cao Anwar S.Raza Department of Pathology and Human Anatomy Loma Linda University Medical CenterLoma LindaCA 92354USA

Hemophagocytic lymphohistiocytosis(HLH)is a cytokine storm syndrome caused by an overactive but ineffective immune *** prompt diagnosis and treatment,HLH is ***,presenting symptoms are often nonspecific,with fatigue and fever being the most common.A high index of suspicion is therefore critical for early diagnosis and timely management.A previously healthy,65-year-old female who initially presented with fever and abdominal pain developed abdominal compartment syndrome(ACS)requiring decompressive laparotomy on hospital day *** frozen sections of biopsied liver showed intense portal lymphohistiocytic ***-Barr virus DNA copy numbers escalated from 600 copies/mL after admission to 134,000 copies/mL before *** diagnostic criteria of HLH-2004 were *** expired on hospital day *** is important to raise awareness of ACS being an unusual presentation of *** changes in diagnostic criteria tailored to adult HLH cases are reviewed.

关键词： Hemophagocytic lymphohistiocytosis abdominal compartment syndrome liver biopsy Epstein-Barr virus

Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1470-1473页

作者： Thibault Vieille Melissa Crotet Celia Turco Paul Monasterolo Hadrien Winiszewski Gael Piton Medical Intensive Care Unit Besancon University HospitalBesancon 25000France Intensive Care Unit Vesoul HospitalVesoul 70000France Department of Digestive Surgical Oncology-Liver Transplantation Unit Besancon University HospitalBesancon 25000France Inserm UMRS-938 Centre de Recherche Saint-Antoine(CRSA)Sorbonne UniversitéParis 10041NY212France Intensive Care Unit Nord Franche Comte HospitalTrevenans 90400France

We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 ***,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly *** report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.

关键词： Acute pancreatitis abdominal compartment syndrome Decompressive laparotomy Mesenteric ischemia Intra-abdominal pressure abdominal perfusion pressure

Effect of laparoscopic abdominal surgery on splanchnic circulation: Historical developments

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World Journal of Gastroenterology 2014年第48期20卷 18165-18176页

作者： Sinan Hatipoglu Sami Akbulut Filiz Hatipoglu Ruslan Abdullayev Department of Surgery Adiyaman University Faculty of Medicine 02040 Adiyaman Turkey Department of Surgery and Liver TransplanInstitute Inonu University Faculty of Medicine 44280 Malatya Turkey Department of Obstetrics and Gynecology Adiyaman University Faculty of Medicine 02040 Adiyaman Turkey Department of Anesthesiology and Reanimation Adiyaman University Faculty of Medicine 02040 Adiyaman Turkey

With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC.

关键词： Laparoscopic abdominal surgery Splanchnic circulation Intra-abdominal pressure abdominal compartment syndrome Safe laparoscopic surgery

Elevated intra-abdominal pressure:A review of current knowledge

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World Journal of Clinical Cases 2022年第10期10卷 3005-3013页

作者： Piotr Łagosz Mateusz Sokolski Jan Biegus Agnieszka Tycinska Robert Zymlinski Department of Heart Diseases Wroclaw Medical UniversityWroclaw 50-367Poland Institute of Heart Diseases University Clinical HospitalWroclaw 50-556Poland Department of Cardiology Medical University of BialystokBialystok 15-089Poland

Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill ***-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ *** IAP affects every system and main organ in the human *** marginally sustained IAH results in malperfusion and may disrupt the process of ***,despite being so common,this potentially lethal condition often goes *** 2004,the World Society of the abdominal compartment syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this ***,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized *** correct,structured approach to treatment can have a striking effect and fully restore *** recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and *** review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.

关键词： abdominal compartment syndrome Intra-abdominal hypertension Intra-abdominal pressure Multiple organ failure abdominal perfusion pressure

Open abdomen in trauma patients:a double-edged sword

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Journal of Medical Colleges of PLA(China) 2016年第2期31卷 59-65页

作者： Yu-hua Huang You-sheng Li Department of General Surgery Jinling Hospital School of Medicine Nanjing University

The use of open abdomen(OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19 th century. Since the 1980 s, OA has become a relatively new and increasingly common strategy to manage massive trauma and abdominal catastrophes. OA has been proven to help reduce the mortality of trauma. Nevertheless, the OA method may be associated with terrible and devastating complications such as enteroatmospheric fistula(EAF). As a result, OA should not be overused, and attention should be given to critical care as well as special management. The temporary abdominal closure(TAC) technique after abbreviated laparotomy was used to improve wound healing and facilitate final fascial closure of OA. Negative pressure therapy(NPT) is the most commonly used TAC method.

关键词： Open abdomen abdominal compartment syndrome Damage control Enteroatmospheric fistula Negative pressure therapy

Study of intra-abdominal hypertension prevalence and awareness level among experienced ICU medical staff

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Journal of Medical Colleges of PLA(China) 2016年第4期31卷 181-187页

作者： Hua-Yu Zhang Dong Liu Hao Tang Shi-Jin Sun Shan-Mu Ai Wen-Qun Yang Dong-Po Jiang Lian-Yang Zhang Trauma Center State Key Laboratory of TraumaBurns and Combined InjuryInstitute of Surgery ResearchDaping HospitalThird Military Medical University

Background:Intra-abdominal hypertension(IAH) is a disease with high morbidity and mortality among critically ill *** study's objectives were to explore the prevalence of IAH and physicians' awareness of the 2013 World Society of abdominal compartment syndrome(WSACS) guidelines in Chinese intensive care units(ICUs).Methods:A cross-sectional study of four ICUs in Southwestern China was conducted from June 17 to August 2,*** patients admitted to the ICU for more than 24 h,with bladder catheter but without obvious intravesical pressure(IVP) measurement contraindications,were *** with more than 5 years of ICU working experience were also *** information,potential IAH risk factors,IVP measurements and questionnaire results were ***:Forty-one patients were ***(36.59%) had IVP?12mm ***(Sequential Organ Failure Assessment) hepatic and neurological sub-scores were utilized as independent predictors for IAH via logistic backward ***-seven intensivists participated in the survey(response rate:80.43%).The average score of each center was less than 35 *** physicians believed the IAH prevalence in their departments was no more than 20.00%.A significant negative correlation was observed between the intensivists' awareness of the 2013 WSACS guidelines and the IAH prevalence in each center(r=-0.975,P=0.025).Conclusion:The prevalence and independent predictors of IAH among the surveyed population are similar to the reports in the *** generally have a low awareness of the 2013 WSACS guidelines.A systematic guideline training program is vital for improving the efficiency of the diagnosis and treatment of IAH.

关键词： Intra-abdominal pressure Intravesical pressure Intra-abdominal hypertension abdominal compartment syndrome Questionnaire

Prevalence and risk factors of organ failure in patients with severe acute pancreatitis

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World Journal of Emergency Medicine 2010年第3期1卷 201-204页

作者： Xiao-yan Li Xiao-bo Wang Xiu-feng Liu Shu-gui Li Department of General Surgery Jinzhong First People’sHospitalJinzhong030600Shanxi ProvinceChina

BACKGROUND： This study was undertaken to determine the prevalence of organ failure and its risk factors in patients with severe acute pancreatitis （SAP） .METHODS： A retrospective analysis was made of 186 patients with SAP who were had been hospitalized in the intensive care unit of Jinzhong First People’s Hospital between March 2000 and October 2009. The patients met the diagnostic criteria of SAP set by the Surgical Society of the Chinese Medical Association in 2006. The variables collected included age, gender, etiology of SAP, the number of comorbidit, APACHEII score, contrast-enhanced CT （CECT） pancreatic necrosis, CT severity index （CTSI） , abdominal compartment syndrome （ACS） , the number of organ failure, and the number of death. The prevalence and mortality of organ failure were calculated. The variables were analyzed by unconditional multivariate logistic regression to determine the independent risk factors for organ failure in ***： Of 186 patients, 96 had organ failure. In the 96 patients, 47 died. There was a significant association among the prevalence of organ failure and age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI, and ACS. An increase in age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis were correlated with increased number of organ failure. Age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI and ACS were assessed by unconditional multivariate logistic ***： Organ failure occurred in 51.6% of the 186 patients with SAP. The mortality of SAP with organ failure was 49.0%. Age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI and ACS are independent risk factors of organ failure.

关键词： Severe acute pancreatitis Organ failure Prevalence Risk factor Age Comorbidity APACHE Pancreatic necrosis abdominal compartment syndrome

Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension

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World Journal of Emergency Medicine 2015年第2期6卷 137-141页

作者： Yuan-zhuo Chen Shu-ying Yan Yan-qing Chen Yu-gang Zhuang Zhao Wei Shu-qin Zhou Hu Peng Department of Emergency Medicine Shanghai Tenth People's HospitalTongji University Coronary Care Unit Shanghai Jiangong Hospital

BACKGROUND: Noninvasive monitoring of intra-abdominal pressure(IAP) by measuring abdominal wall tension(AWT) was effective and feasible in previous postmortem and animal studies. This study aimed to investigate the feasibility of the AWT method for noninvasively monitoring IAP in the intensive care unit(ICU).METHODS: In this prospective study, we observed patients with detained urethral catheters in the ICU of Shanghai Tenth People's Hospital between April 2011 and March 2013. The correlation between AWT and urinary bladder pressure(UBP) was analyzed by linear regression analysis. The effects of respiratory and body position on AWT were evaluated using the paired samples t test, whereas the effects of gender and body mass index(BMI) on baseline AWT(IAP<12 mm Hg) were assessed using one-way analysis of ***: A total of 51 patients were studied. A significant linear correlation was observed between AWT and UBP(R=0.986, P<0.01); the regression equation was Y=–1.369+9.57X(P<0.01). There were signif icant differences among the different respiratory phases and body positions(P<0.01). However, gender and BMI had no signif icant effects on baseline AWT(P=0.457 and 0.313, respectively).CONCLUSIONS: There was a signif icant linear correlation between AWT and UBP and respiratory phase, whereas body position had signif icant effects on AWT but gender and BMI did not. Therefore, AWT could serve as a simple, rapid, accurate, and important method to monitor IAP in critically ill patients.

关键词： abdominal wall tension Intra-abdominal pressure Noninvasive monitoring abdominal compartment syndrome