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首页> 外文期刊>Journal of endovascular therapy: an official journal of the International Society of Endovascular Specialists >Tissue plasminogen activator-assisted hematoma evacuation to relieve abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm
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Tissue plasminogen activator-assisted hematoma evacuation to relieve abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm

机译：纤溶酶原激活物辅助的血肿清除术可缓解腹主动脉瘤破裂的血管内修复后的腹腔综合征

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Purpose: To describe our experience with a novel technique to decompress abdominal compartment syndrome after endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA). Method: From January 2003 to April 2010, 13 patients (12 men; mean age 75 years) treated for rAAA with EVAR underwent tissue plasminogen activator (tPA)-assisted decompression for intra-abdominal hypertension. All of the patients but one had intra-abdominal pressure >20 mmHg, with signs of multiple organ failure or abdominal perfusion pressure <60 mmHg. With computed tomography guidance, a drain was inserted into the retroperitoneal hematoma, and tPA solution was injected to facilitate evacuation of the coagulated hematoma and decrease the abdominal pressure. Results: In the 13 patients, the mean intra-abdominal pressure decreased from 23.5 mmHg (range 12-35) to 16 mmHg (range 10-28.5). A mean 1520 mL (range 170-2900) of blood was evacuated. Urine production (mean 130 mL/h, range 50-270) increased in 7 patients at 24 hours after tPA-assisted decompression; among the 5 patients in which urine output did not increase, 3 underwent hemodialysis by the 30-day follow-up. One patient did not respond with clinical improvement and required laparotomy. The 30-day, 90-day, and 1-year mortality was 38% (5/13 patients); none of the deaths was related to the decompression technique. Conclusion: tPA-assisted decompression of abdominal compartment syndrome after EVAR can decrease the intra-abdominal pressure and could be useful in preventing multiple organ failure. It is a minimally invasive technique that can be used in selected cases but does not replace laparotomy or retroperitoneal surgical procedures as the gold standard treatments.
机译：目的：描述我们在破裂腹主动脉瘤（rAAA）的血管内动脉瘤修复（EVAR）后减压腹腔室综合征的经验。方法：自2003年1月至2010年4月，对13例接受EVAR治疗的rAAA患者（12名男性，平均年龄75岁）进行了组织纤溶酶原激活剂（tPA）辅助减压治疗腹腔高压。除一名患者外，所有患者腹腔内压力均> 20 mmHg，有多器官功能衰竭或腹腔灌注压<60 mmHg的迹象。在计算机断层扫描引导下，将引流管插入腹膜后血肿，并注入tPA溶液以促进凝结血肿的排空并降低腹部压力。结果：13例患者的平均腹腔内压力从23.5 mmHg（范围12-35）降至16 mmHg（范围10-28.5）。抽出平均1520 mL（170-2900）的血液。 tPA辅助减压后24小时，有7名患者的尿液产量（平均130 mL / h，范围为50-270）增加;在5例尿量没有增加的患者中，有3例在30天的随访中进行了血液透析。一名患者对临床改善无反应，需要剖腹手术。 30天，90天和1年的死亡率为38％（5/13例）。没有人死亡与减压技术有关。结论：经tPA辅助的EVAR可使腹腔综合征减压，可降低腹腔内压力，可用于预防多器官功能衰竭。这是一种微创技术，可以在特定情况下使用，但不能代替剖腹手术或腹膜后手术作为金标准治疗方法。

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