Objective: To investigate the diagnosis and treatment of abdominal compartment syndrome (ACS) in critical surgical patients. Methods: The clinical data of 26 critical surgical patients with ACS undergoing surgical or non-surgical treatment in our hospital from April 2007 to December 2011 were retrospectively analyzed. The intra-abdominal pressure alteration of the patients before and after treatment and its relations with alterations of abdominal perfusion pressure, urine volume, lactic acid concentration, high-sensitivity C-reactive protein level and APACHE II score were analyzed. The clinical efficacies of the two treatment modalities were compared, and the prognostic factors of the patients were also determined. Results: The intra-abdominal pressure of the patients decreased by either surgical or non-surgical approaches, meanwhile, the physiochemical indexes (abdominal perfusion pressure, urine volume, lactic acid concentration, high-sensitivity C-reactive protein level and APACHE II score) of the patients were also improved (all P<0.05). The intra-abdominal pressure of the patients undergoing surgical treatment reduced more significantly than that of the patients undergoing non-surgical treatment (P=0.011). Intra-abdominal pressure level, high-sensitivity C-reactive protein level and APACHE II score were independent risk factors affecting the prognosis of patients. Conclusion: Surgical intervention should be performed aggressively to the critical surgical patients with ACS. Furthermore, the inflammatory response is an important factor affecting the prognosis of those patients.