Abdominal Compartment Syndrome in Severe Contact Burn Injury-A Case Report

嚴重接觸燙傷併發腹部腔室症候群之病例報告

高文彬(Wen-Pin Kao) ； 唐友文(Yu-Wen Tang) ； 簡文祥(Jung-Hsing Yen) ； 林雍球(Yung-Chiou Lin) ； 顏榮信(Jung-Hsing Yen) ； 陳伊呈(I-Chen Chen) ； 宋定宇(Dung-Yeu Sung)

《中華民國整形外科醫學會雜誌》 18卷3期 (2009/09) Pp. 283-287

https://doi.org/10.7096/JPSA.200909.0283

摘要

背景：
通常腹部腔室症候群是腹部重大手術或外傷之併發症。而文獻上也有幾例嚴重燒燙傷併發腹部腔室症候群的病例報告。而嚴重接觸性燙傷併發腹部腔室症候群的病例更是少見。
目的及目標：
腹部腔室症候群的特徵包括：繃緊的腹脹、腹內高壓、心臟功能不全，肺臟順應性下降以及腎臟功能受損等等。嚴重的燒燙病患本來就有生命危險，如果加上併發腹部腔室症候群，其死亡率更是上升。如何能在這些病患身上早期監測並早期診斷腹部腔室症候群，及早安排後續處理與治療將可提高病患的存活率。
材料及方法：
我們在此提出一個嚴重接觸燙傷併發腹部腔室症候群之病例報告，並回顧了一些相關的文獻。
結果：
我們認為常規的為這些嚴重燙傷病患每4小時監測膀胱內壓力能幫助我們盡早診斷與治療腹內高壓及腹部腔室症候群。如果膀胱內壓力大於25毫米汞柱，則應將監測頻率縮短為2小時一次。
結論：
一旦有腹部腔室症候群的症狀出現（包括心臟，肺臟，腎臟功能受影響，以及下肢血循不良），就應該立即實行減壓手術以提高病患之存活率。

並列摘要

Background:
Abdominal compartment syndrome (ACS) typically develops as a postoperative complication in patients following abdominal surgery or abdominal trauma.
Aim and Objectives:
ACS is characterized by a tensely distended abdomen, intra-abdominal hypertension (IAH), reduced cardiac output, increased peak airway pressures with hypoxia and hypercarbia, and disturbed renal function.
Materials and Methods:
An adult case of ACS following a major contact burn is presented along with a review of the literature. For these major burn patients, we think routine monitoring of bladder pressure every 4 hours in the first 3 day led us to diagnosis and treat IAH and ACS early. If the intra-abdominal pressure (IAP) above 25 mmHg, we must repeat the measurement every 2 hours to monitor the response to therapy.
Results:
The ACS may compromise the lower limbs' circulation, pulse oximetry on his toe maybe benefit for monitor his condition.
Conclusion:
Emergent exploratory laparotomy must be carried out immediately when ACS signs (including cardiopulmonary distress, disturbed renal function and lower limbs' circulation compromised) attacked.

並列關鍵字

contact burn ； abdominal compartment syndrome