Intraabdominalni tlak in utesnitveni sindrom trebuha Intraabdominal pressure and intraabdominal compartment syndrome

Abstract

Utesnitveni sindrom trebuha (abdominalni kompartment sindrom) zelo poveča obolevnost in umrljivost bolnikov v intenzivnih enotah. V prispevku je predstavljen z vidika definicij, patofiziologije, vzrokov in načinov zdravljenja. Vzroki za zvišan intraabdominalni tlak in utesnitveni sindrom trebuha so bolezenska dogajanja v trebuhu in zunaj njega, pomemben dejavnik pa je tudi zdravljenje teh bolezni s čezmernimi količinami tekočin, zlasti kristaloidov. Ena ključnih patofizioloških posledic zvišanega intraabdominalnega tlaka je znižanje perfuzijskega tlaka in s tem prekrvitve organov v trebuhu. Intraabdominalni tlak znižamo z ukrepi za večjo popustljivost trebušne stene, z zmanjšanjem vsebine v trebušni votlini, z manjšo obremenitvijo s tekočinami ter z zdravljenjem osnovnega obolenja. Skrajni ukrep, ki pa mora biti pravočasen, je kirurško odprtje trebuha.

Abstract (Eng)

Intraabdominal compartment syndrome increases significantly the morbidity and mortality of ICU patients. In the present article, this complication is explained through definitions, pathophysiology, etiology and treatment doctrine. The increased intraabdominal pressure and intraabdominal compartment syndrome can be related to the pathological changes in the abdominal cavity as well as to the extraabdominal causes. The excessive fluid resuscitation, in particular with crystalloids in acute critical illness is an important risk factor as well. One of the most serious pathophysiological consequences of the increased intraabdominal pressure is the decrease of perfusion pressure and thereby also of blood perfusion of the abdominal organs. The measures to reduce the intraabdominal pressure include: measures to improve the abdominal wall compliance, measures to reduce the content of the abdominal cavity, reduction of the intravascular fluid therapy and the treatment of the primary disease. In worst cases, the surgical abdominal decompression should be performed without delay.