Medida da pressão intra-abdominal após colocação de compressas ao redor do fígado: estudo experimental em porcos / Intra-abdominal pressure measurement after sponge placement around the liver: experimental study in pigs

INTRODUÇÃO: A síndrome compartimental abdominal (SCA) é uma complicação frequente da cirurgia de controle de dano, podendo ocorrer em até 33% dos casos. A medida da pressão intra-abdominal para diagnóstico da SCA é avaliada através da pressão intravesical. OBJETIVO: Avaliar, através de modelo experimental, as repercussões da colocação de compressas sobre a pressão intravesical e em diferentes regiões do abdome. MÉTODO: Foram utilizados 10 porcos machos, entre 45 e 60 dias, com peso entre 15 e 18 kg, submetidos a laparotomia exploradora para colocação de compressas e avaliação de medidas de pressão no espaço supra-hepático (Psh), espaço infra-hepático (Pih), espaço subfrênico esquerdo (Psfe), veia cava inferior (Pvci), veia porta (Pvp) e bexiga (Pv). Foi também avaliada a pressão arterial média (PAM) e o débito cardíaco. As diferentes medidas de pressão foram comparadas no mesmo animal com diferentes tipos de fechamento da parede abdominal: bolsa de Bogotá (CCB), total da aponeurose (CCAF), pele (CCPF) e total da pele e aponeurose (CF). Os resultados foram submetidos a análise estatística. RESULTADOS: Não houve diferença (p>0,05) entre as medidas de PAM em todas as fases de fechamento do abdome. A pressão de veia cava inferior e a pressão intravesical foram diferentes (p<0,05) entre os grupos CF e CCAF. Psfe, Psfd e Psh foram diferentes (p<0,05) entre CF e CCB, CF e CCPF e CF e CCAF. Foram diferentes (p<0,05) Pv e Psfd, Pv e Psh e Psfe e Psfd nos grupos CCB, CCPF e CCAF. No grupo CCAF ainda foram diferentes (p<0,05) Pv e Psfe e Psh e Psfd. A avaliação de Pvp mostrou-se diferente (p<0,05) em relação ao grupo controle (CF) nos grupos CCB, CCPF e CCAF, e ainda entre CCB e CCAF. CONCLUSÃO: A pressão intra-abdominal não é uniforme quando são colocadas compressas na cavidade peritoneal. A pressão vesical é menor que em outras regiões da cavidade peritoneal. As pressões não ultrapassaram níveis de Síndrome Compartimental Abdominal.

INTRODUCTION: Abdominal compartment syndrome is a frequent complication of damage control surgery and can occur in approximately 33% of cases. Diagnosis of abdominal compartment syndrome depends on measurement of abdominal pressure which is usually assessed through intravesical pressure. OBJECTIVE: Evaluate the consequences of liver packing with sponges to the intravesical pressure and to pressures in different sites of the abdomen in an animal experimental model. METHODS: 10 adult male pigs, aged 45 to 60 days, weighing 15 to 18 kg, underwent laparotomies for liver packing and evaluation of pressures in suprahepatic space (Psh), infrahepatic space (Pih), left subphrenic space (Psfe), inferior vena cava (Pvci), portal vein (Pvp) and bladder (Pv). Other variables such as mean arterial pressure and cardiac output, were also measured. Different pressure measurements were compared in the same animal with different types of closures of the abdominal wall: Bogota bag (CCB), total closure of aponeurosis (CCAF), skin closure (CCPF) and total skin and aponeurosis closure (CF). Results were analyzed statistically. RESULTS: There was no difference (p>0,05) between mean arterial blood pressure in all phases of abdominal closure. Pressure in inferior vena cava and intravesical pressure were different (p<0,05) in groups CF and CCAF. Psfe, Psfd and Psh were different (p<0,05) between CF vs CCB, CF vs CCPF and CF vs CCAF. Pv vs Psfd, Pv vs Psh and Psfe vs Psfd were different (p<0,05) in groups CCB, CCPF and CCAF. In group CCAF, Pv vs Psfe and Psh vs Psfd were also different (p<0,05). Evaluation of Pvp has shown to be different (p<0,05) when compared to control group (p<0,05) in groups CCB, CCPF and CCAF, and also between CCB and CCAF. CONCLUSION: Intra-abdominal pressure is not uniform when sponges are placed in the abdomen. Intravesical pressure is lower than pressures in other sites of the peritoneal cavity. No pressure measurement reached levels of abdominal compartment...

Evaluation of unenhanced multislice helical CT in acute infrequent abdominal trauma / 重庆医科大学学报

Objective:To recognize the diagnostic value of emergency unenhanced CT without oral contrast material in the diagnosis of infrequent abdomen injury.Methods:990 patients with abdomen symptoms underwent plain scan using 16-row spiral CT without oral contrast material;their CT pictures were noted to find adrenal gland,pancreas,and hollow viscus injure.All cases underwent laparotomy or follow-up CT visit.The initial CT results were compared with the operative and follow-up outcome.Results:In the 990 patients with abdomen symptoms,there were 12 cases of adrenal gland injuries;17 cases of pancreas injuries,and 26 cases of hollow viscus injuries.Compared with operative and follow-up outcome,there was 0 false-negative and 0 false-positive in adrenal gland injury and the sensitivity was 100%;there were 2 false-negatives and 3 false-positives in pancreas injury and the sensitivity was 83.3%;there were 6 false-negatives and 7 false-positives in hollow visceral injury and the sensitivity was 76%.Conclusion:16-slice spiral CT has high diagnostic value in acute infrequent abdomen injury,The diagonostic sensitivity is higher to adrenal gland injury,but relatively lower to hollow viscus injury.

Emergency damage control treatment for the severe abdomen trauma of 192 cases / 中国现代普通外科进展

Objective: To explore the application experiences and effects of emergency damage contro(lDC)treatment for severe abdomen trauma. Methods: The clinical data of 192 patients with severe abdomen trauma were selected as the object of this study. A retrospective analysis was done on therapy condition and effects of emergency damage control treatments. Results: Pre-hospital emergency care was performed in all 192 patients, damage control operations (DCO)were done in 186 cases, 184 cases entered surgical intensive care unit (SICU)for resuscitation, and 177 cases were adopted corresponding reoperations after SICU resuscitation. The abnomal DCO indices recovered gradually in the 72 hours after DCO. The cure rate was 90.7% with 174 cases, and the incidence of complication was as low as 2.3% with 4 cases after reoperations, and the 4 cases all healed by conservative treatments. Mortality rate was 6.2% with 12 cases, and it caused by associated organs injuries, severe primary disease and secondary infection of other organs. Conclusion: Emergency damage control treatment modus should be chosen positively and eligibly under indication to severe abdomen trauma patients. According to the difference of location and degree of injury, eligible therapies by stages are the key managements.