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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,PE on Admission,T 38, HR 140bpm, RR 30/min, BP 82/58mmHg Ox
2、ygen 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,Lab Examination on Ad,Hb 18g/
3、dl WBC 11300/mm3( N0.88 L0.09) Platelet 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, PaO2 55mmHg, PaCO2 28 mmHg, BE 14.5mmol/L CT: Diffusive necrosis of pancreas, massive ascites, left pleural effusion,Diagnos
4、is,Severe acute pancreatitis ARDS ARF Shock Abdominal compartment syndrome,Treatment,Intubation, tracheostomy,mechanical ventilation Fluid resuscitation and anti-shock therapy Intraabdominal irrigation by laparoscopy, continous draining by persistent negative pressure Continuous venovenous high volu
5、me hemofiltration Anti-acid therapy and Inhibition of pancreatic secretion prophylactic antibiotic theray,Advancement of the Illness and Outcome of the Patient,3rd hospital day, developed “Abdominal Compartment Syndrome ”, and received the 2nd emergent operation as abdominal opening and gastrointest
6、inal fistulization to relieve the abdominal high pressure,Intraabdominal pressure were indirectly measured by bladder pressure measurement.,He experienced massive abdominal hemorrhage for two times, and even the 3rd emergent operation was performed for hemostasis and necrosis tissue cleaning Various
7、 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,Advancement of the Illness and Outcome of the Patient,14th day, intestinal function partially recovered and TPN was grad
8、ually switched to enteral nutrition 28th day, CVVH discontinued, urine output increased to more than 2000ml/d . 36th day, mechanical ventilation ceased serum creatinine returned to normal range on 48th day 39th day, and 57th day, received two times of postage stamp autodermoplasty for skin defect in
9、 abdomen 161st day, after a CT scan confirming that pancreatic necrosis and effusion well absorbed, discharged,腹腔内压力的变化（膀胱测压法）,吸入氧浓度和血气的变化,心率的变化,尿量的变化,MAP,HR Changes and Dopamine/Noradrenine Dose Adjustment,PaO2/FiO2 Changes,Urine Output and BUN, SCr Changes during CBP,CHVHF(4L/h),CVVH(2L/h),CVVH Discontinued,Serum electrolytes Changes during CHVHF,CHVHF day,Arterial pH Changes during CHVHF,Arterial pH,Arterial HCO3- and BE Level Changes during CHVHF,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,Thank you !,