在创伤或紧急手术后开放腹部管理的ICU必需品
Jennifer Marie Leonard1, Maurizio Cecconi2,3, Lewis J Kaplan4,5
1Division of Trauma and Acute Care Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
在重症监护室 (ICU) 管理开放的腹部需要注意腹腔内高血压 (IAH) 和腹腔综合征 (ACS). 优化一次性关闭 (PFC) 对患者的治疗结果至关重要.
科学领域:
- 临界护理医学 临界护理医学
- 手术管理的手术管理.
- 重症监护室 (ICU) 协议 密切护理单位 (ICU) 协议
背景情况:
- 开放腹部方法经常用于创伤,紧急整体手术 (EGS),以及在ICU中管理腹腔内高血压 (IAH) 和腹腔综合征 (ACS).
- 在心脏手术和心脏移植中,IAH越来越被认可,超越了传统的适应症.
- 技术进步正在改善IAH监测,重点关注非侵入性设备.
研究的目的:
- 审查目前的实践和新出现的证据,在重症监护机构的开放腹部管理.
- 突出及时初级带关闭 (PFC) 对患者结局的重要性.
- 讨论管理IAH/ACS和优化ICU患者护理的策略.
主要方法:
- 文献综述侧重于开放腹部管理,IAH,ACS和初级带关闭.
- 对IAH流行,监测和管理策略的最新发现进行分析.
- 综合证据关于影响患者结果的因素,包括关闭时间和营养支持.
主要成果:
- 在各种重症监护场景中,IAH很普遍,包括心脏手术和心脏移植.
- 及时的初级带关闭 (PFC) 是患者结果的关键决定因素;延迟关闭与更糟糕的结果有关.
- 技术进步为IAH提供了改进的非侵入性监测.
- 营养支持和以团队为基础的管理策略对于优化开腹患者的结果至关重要.
结论:
- 在ICU开放腹部患者的有效管理需要全面的方法来解决复苏,腹内压力监测和营养支持.
- 实现初级带关闭 (PFC) 是一个关键的目标,不管最初留下腹部开放的原因是什么.
- 临床医生必须将当前的证据纳入实践,以改善需要开腹管理的患者的治疗结果.
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