rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2006-6-123-128rmt-1372Research ArticleОСТРЫЙ ПАНКРЕАТИТACUTE PANCREATITISМониторинг внутрибрюшного давления у больных острым панкреатитомAbdominal Pressure Monitoring in Patients with Acute PancreatitisЛяминА. Ю.LyaminA. Yu.НикифоровЮ. В.NikiforovYu. V.МорозВ. В.MorozV. V.ГУ НИИ общей реаниматологии РАМН, Москва ГКБ № 15 им. О. М. Филатова Департамента здравоохранения МосквыResearch Institute of General Reanimatology, Russian Academy of Medical Sciences; O. M. Filatov City Clinical Hospital No. 15, Moscow20062012200626Том II № 5-6 2006 г.123128Copyright © Лямин А.Ю., Никифоров Ю.В., Мороз В.В., 20062006Лямин А.Ю., Никифоров Ю.В., Мороз В.В.Lyamin A.Y., Nikiforov Y.V., Moroz V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1372

Целью настоящего исследования является оценка возможности использования мониторинга внутрибрюшного давления у пациентов острым панкреатитом, панкреонекрозом после эндоскопического дренирования брюшной полости.

Материалы и методы

Материалы и методы. Представлен анализ мониторинга внутрибрюшного давления у 94 больных с острым панкреатитом, жировым или геморрагическим панкреонекрозом. Больные разделены на 3 группы в зависимости от степени интенсивности и длительности развития внутрибрюшной гипертензии. Анализировалась тяжесть состояния по шкале APACHE II, внутрибрюшное давление, длительность его повышения, реакция внутрибрюшного давления на проведение перитонеального лаважа, характер и число органной дисфункции.

Результаты

Результаты. Длительный подъем внутрибрюшного давления у больных острым панкреатитом, панкреонекрозом, несмотря на лапароскопическое дренирование брюшной полости, развивается в 41,5% случаев. Корреляция между оценкой тяжести состояния по шкале APACHE II и внутрибрюшным давлением начинается при развитии I степени внутрибрюшной гипертензии. Верхняя граница субъективной переносимости внутрибрюшной гипертензии составляет 26,4±3,24 см вод.ст.

The purpose of the study was to determine whether abdominal pressure could be monitored in patients with acute pancreatitis, pancreonecrosis after endoscopic drainage of the abdomen.

Materials and methods

Materials and methods. The results of abdominal pressure monitoring were analyzed in 94 patients with acute pancreatitis, fatty or hemorrhagic pancreonecrosis. According to the severity and duration of abdominal hypertension, the patients were divided into 3 groups. The authors analyzed their condition by the APACHE II scale, abdominal pressure, the duration of its elevation, an abdominal pressure response to peritoneal lavage, the pattern and number of organ dysfunctions.

Results

Results. In patients with acute pancreatitis or pancreonecrosis, a long abdominal pressure rise occurs in 41.5% of cases despite laporoscopic drainage of the abdomen. A correlation between the evaluation of their condition by the APACHE II scale and abdominal pressure starts when grade 1 abdominal hypertension develops. The upper range of subjective abdominal hypertension tolerability is 26.4±3.24 cm H2O.

ReferencesСавельев В. С., Гельфанд Б. Р., Гологорский В. А. Деструктивный панкреатит в свете современных представлений о сепсисе. Анналы хирургии 1999; 5: 26—29.Савельев В. С., Гельфанд Б. Р., Гологорский В. А. Деструктивный панкреатит в свете современных представлений о сепсисе. Анналы хирургии 1999; 5: 26—29.Wilson C., Imrie C., Carter D. Fatal acute pancreatitis. Gut 1988; 29: 782—788.Wilson C., Imrie C., Carter D. Fatal acute pancreatitis. Gut 1988; 29: 782—788.Mann D., Hershman M., Hittinger R., et al. Multicentre audit of death from acute pancreatitis. Br. J. Surg. 1994; 81: 890—893.Mann D., Hershman M., Hittinger R., et al. Multicentre audit of death from acute pancreatitis. Br. J. Surg. 1994; 81: 890—893.Renner I., Savage W., Pantoja J. et al. Death due to acute pancreatitis: a retrospective analysis of 405 autopsy cases. Dig. Dis. Sci. 1985; 30: 1005—1018.Renner I., Savage W., Pantoja J. et al. Death due to acute pancreatitis: a retrospective analysis of 405 autopsy cases. Dig. Dis. Sci. 1985; 30: 1005—1018.Buggy B., Nostrant T. Lethal pancreatitis. Am. J. Gastroenterol. 1983; 78: 810—814.Buggy B., Nostrant T. Lethal pancreatitis. Am. J. Gastroenterol. 1983; 78: 810—814.Allardyce D. Incidence of necrotizing pancreatitis and factors related to mortality. Am. J. Surg. 1987; 154: 295—299.Allardyce D. Incidence of necrotizing pancreatitis and factors related to mortality. Am. J. Surg. 1987; 154: 295—299.De Bolla A., Obeid M. Mortality in acute pancreatitis. Ann. R. Coll. Surg. Engl. 1984; 66: 184—186.De Bolla A., Obeid M. Mortality in acute pancreatitis. Ann. R. Coll. Surg. Engl. 1984; 66: 184—186.Imrie C., McKay A., Benjamin I. et al. Secondary acute pancreatitis: aetiology, prevention, diagnosis and management. Br. J. Surg. 1978; 65: 399—402.Imrie C., McKay A., Benjamin I. et al. Secondary acute pancreatitis: aetiology, prevention, diagnosis and management. Br. J. Surg. 1978; 65: 399—402.Bradley E. L. III. A clinicallly based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis. Atlanta; 1992. 586—590.Bradley E. L. III. A clinicallly based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis. Atlanta; 1992. 586—590.Савельев В. С., Гельфанд Б. Р., Гологорский В. А. и др. Системная воспалительная реакция и сепсис при панкреонекрозе. Анестезиология и реаниматология 1999; 6: 28—33.Савельев В. С., Гельфанд Б. Р., Гологорский В. А. и др. Системная воспалительная реакция и сепсис при панкреонекрозе. Анестезиология и реаниматология 1999; 6: 28—33.Савельев В. С., Филимонов М. И., Бурневич С. З. Вопросы классификации и хирургического лечения при панкреонекрозе. Анналы хирургии 1999; 4: 34—38.Савельев В. С., Филимонов М. И., Бурневич С. З. Вопросы классификации и хирургического лечения при панкреонекрозе. Анналы хирургии 1999; 4: 34—38.United Kindom guidelines for the management of acute pancreatitis. Gut 1998; 42 (Suppl. 2): S1—S13.United Kindom guidelines for the management of acute pancreatitis. Gut 1998; 42 (Suppl. 2): S1—S13.Ranson J., Rifkind K., Roses D. Prognostic signs and the role of operative management in acute pancreatitis. Surg. Gynecol. Obstet. 1974; 139: 69—81.Ranson J., Rifkind K., Roses D. Prognostic signs and the role of operative management in acute pancreatitis. Surg. Gynecol. Obstet. 1974; 139: 69—81.Wilson C., Heath D., Imrie C. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br. J. Surg. 1990; 77: 1260—1264.Wilson C., Heath D., Imrie C. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br. J. Surg. 1990; 77: 1260—1264.Larvin M., McMahon M. APACHE II score for assessment and monitoring of acute pancreatitis. Lancet 1989; 11: 201—205.Larvin M., McMahon M. APACHE II score for assessment and monitoring of acute pancreatitis. Lancet 1989; 11: 201—205.Kirkpatrick A. W., Brenneman F. D., McLean R. F. et al. Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? C. J. S. 2000; 43 (3): 207—211.Kirkpatrick A. W., Brenneman F. D., McLean R. F. et al. Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? C. J. S. 2000; 43 (3): 207—211.Malbrain M. L. Abdominal pressure in the critically ill. Curr. Opin. Crit. Care 2000; 6: 17—29.Malbrain M. L. Abdominal pressure in the critically ill. Curr. Opin. Crit. Care 2000; 6: 17—29.Robotham J. L., Wise R. A., BrombergerZBarnea B. Effects of changes in abdominal pressure on left ventricular performance and regional blood flow. Crit. Care Med. 1985; 10: 803—809.Robotham J. L., Wise R. A., BrombergerZBarnea B. Effects of changes in abdominal pressure on left ventricular performance and regional blood flow. Crit. Care Med. 1985; 10: 803—809.Barnes G. E., Laine G. A., Giam P. Y. et al. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am. J. Physiol. 1988; 248: R208—R213.Barnes G. E., Laine G. A., Giam P. Y. et al. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am. J. Physiol. 1988; 248: R208—R213.Ho K. W., Joynt G. M., Tan P. A comparison of central venous pressure and common iliac venous pressure in critically ill mechanically ventilated patients. Crit. Care Med. 1998; 26: 461—464.Ho K. W., Joynt G. M., Tan P. A comparison of central venous pressure and common iliac venous pressure in critically ill mechanically ventilated patients. Crit. Care Med. 1998; 26: 461—464.Pickhardt P. J., Shimony J. S., Heiken J. P. et al. The abdominal compartment syndrome: CT findings. A. J. R. 1999; 173: 575—579.Pickhardt P. J., Shimony J. S., Heiken J. P. et al. The abdominal compartment syndrome: CT findings. A. J. R. 1999; 173: 575—579.Richardson J. D., Trinkle J. K. Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J. Surg. Res., 1976; 20: 401—404.Richardson J. D., Trinkle J. K. Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J. Surg. Res., 1976; 20: 401—404.Rubinson R. M., Vasco J. S., Doppman J. L., Morrow A. G. Inferior caval obstruction fron increased intra-abdominal pressure. Arch. Surg. 1967; 94: 766—770.Rubinson R. M., Vasco J. S., Doppman J. L., Morrow A. G. Inferior caval obstruction fron increased intra-abdominal pressure. Arch. Surg. 1967; 94: 766—770.Wachsberg R. H., Sebastiano L. L., Levine C. D. Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure. Abdom. Imaging 1998; 23 (1): 99—102.Wachsberg R. H., Sebastiano L. L., Levine C. D. Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure. Abdom. Imaging 1998; 23 (1): 99—102.Hering R., Rudolph J., Spiegel T. V. et al. Cardiac filling pressures are inadequate for estimating circulatory volume in states of elevated intraabdominal pressure. Intensive Care Med. 1998; 24 (Suppl): S409.Hering R., Rudolph J., Spiegel T. V. et al. Cardiac filling pressures are inadequate for estimating circulatory volume in states of elevated intraabdominal pressure. Intensive Care Med. 1998; 24 (Suppl): S409.Sugerman H. J. Bloomfield G. L., Saggi B. W. Multisystem organ failure secondary to increased intraabdominal pressure. Infection 1999; 27: 61—66.Sugerman H. J. Bloomfield G. L., Saggi B. W. Multisystem organ failure secondary to increased intraabdominal pressure. Infection 1999; 27: 61—66.Сullen D. J., Coyle J. P., Teplick R., Long M. C. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit. Care Med., 1989; 17: 118—121.Сullen D. J., Coyle J. P., Teplick R., Long M. C. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit. Care Med., 1989; 17: 118—121.Obeid F., Saba A., Fath J., et al. Increases in intra-abdominal pressure affect pulmonary compliance. Arch. Surg. 1995; 130: 544—548.Obeid F., Saba A., Fath J., et al. Increases in intra-abdominal pressure affect pulmonary compliance. Arch. Surg. 1995; 130: 544—548.Schein M., Wittman D. H., Aprahamian C. C., Condon R. E. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J. Am. Col. Surg. 1995; 180: 745—753.Schein M., Wittman D. H., Aprahamian C. C., Condon R. E. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J. Am. Col. Surg. 1995; 180: 745—753.Motev M., Ivankovich A., Bieniarz J. et al. Cardiovascular effects and acid-base and blood gas changes during laparoscopy. Am. J. Obstet. Gynecol. 1973; 115: 1002—1012.Motev M., Ivankovich A., Bieniarz J. et al. Cardiovascular effects and acid-base and blood gas changes during laparoscopy. Am. J. Obstet. Gynecol. 1973; 115: 1002—1012.Bongard F., Pianim N., Dubecz, Klein S. R. Adverse Consequences of increased intra-abdominal pressure on bowel tissue oxygen. J. Trauma 1995; 3: 519—525.Bongard F., Pianim N., Dubecz, Klein S. R. Adverse Consequences of increased intra-abdominal pressure on bowel tissue oxygen. J. Trauma 1995; 3: 519—525.Bloomfield G. L., Ridings P. C., Blocher C. R. et al. A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit. Care Med. 1997; 25: 496—503.Bloomfield G. L., Ridings P. C., Blocher C. R. et al. A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit. Care Med. 1997; 25: 496—503.Sugrue M., Jones F., Lee A. et al. Intraabdominal pressure and gastric intramucosal pH: is there an association? World. J. Surg. 1996; 20: 988—991.Sugrue M., Jones F., Lee A. et al. Intraabdominal pressure and gastric intramucosal pH: is there an association? World. J. Surg. 1996; 20: 988—991.Сaldwell C. B., Ricotta J. J. Changes in visceral blood flow with elevated intraadominal pressure. J. Surg. Research 1987; 43:14—20.Сaldwell C. B., Ricotta J. J. Changes in visceral blood flow with elevated intraadominal pressure. J. Surg. Research 1987; 43:14—20.Diebel L. N., Dulchavsky S. A., Wilson R. F. Effect of increased intraabdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J. Trauma 1992; 1: 45—49.Diebel L. N., Dulchavsky S. A., Wilson R. F. Effect of increased intraabdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J. Trauma 1992; 1: 45—49.Bongard F., Pianim N., Dubecz, Klein S. R. Adverse consequences of increased intra-abdominal pressure on bowel tissue oxygen. J. Trauma 1995; 3: 519—525.Bongard F., Pianim N., Dubecz, Klein S. R. Adverse consequences of increased intra-abdominal pressure on bowel tissue oxygen. J. Trauma 1995; 3: 519—525.

The authors declare that there are no conflicts of interest present.