Внутрішньочеревна гіпертензія як ускладнення гострого панкреатиту

Abstract

The aim of our work was to review modern aspects of pathogenesis, diagnosis and treatment of intra-abdominal hypertension as a complication of the severe course of acute pancreatitis. Acute pancreatitis is a systemic disease, the severe course of which is associated with organ dysfunction and increased intra-abdominal pressure. The frequency of intra-abdominal hypertension in patients with severe acute pancreatitis is 60%, while 10-30% of patients in this category hospitalized in the intensive care unit have abdominal compartment syndrome. An increase in intraabdominal pressure has a negative effect on the course of acute pancreatitis. Namely, multiple organ failure occurs more often; pancreatic and peripancreatic necrosis, prolonged systemic inflammatory response syndrome, complications during the use of enteral nutrition, the need for invasive interventions, the length of hospitalization and the percentage of deaths increase. Determination of intra-abdominal pressure through the urinary bladder in patients with severe acute pancreatitis should be considered as a standard for diagnosing intraabdominal hypertension. It has been proven that the use of paracentesis with drainage of the abdominal cavity in the staged treatment of patients with a complicated course of acute pancreatitis (peripancreatic accumulation of fluid in the early period of the disease) reliably reduces intra-abdominal pressure after 72 h since the detection of fluid (17.4 ± 2.6 and 11.4 ± 1.6 mm Hg), serum amylase (774.3 ± 233.9 and 472.7 ± 168.6 Units/l), procalcitonin (1.3 ± 0.7 and 0.6 ± 0.5 ng/ml) and interleukin-6 (531.3 ± 120.9 and 417.1 ± 82.4 pg/ml). Achievements in intensive care, optimization of indications for surgical interventions, early enteral nutrition, rational use of liquid resuscitation and the growing role of minimally invasive interventions have had a positive effect on the prognosis of acute pancreatitis, overall morbidity and led to a decrease in deaths in this category of patients. However, the prevention and treatment of persistent intra-abdominal hypertension and abdominal compartment syndrome require further study and improvement.