Uticaj intraabdominalnog pritiska na stepen nekroze pankreasa kod bolesnika sa teškom formom akutnog pankreatitisa

Abstract

Cilj ove studije je bio da ispita uticaj intraabdominalnog pritiska na stepen nekroze pankreasa kod bolesnika sa akutnim pankreatitisom. Metode. Istraživanje je obuhvatilo 80 bolesnika, oba pola, obolelih od akutnog pankreatitisa hospitalizovanih u Klinici za opštu hirurgiju i Klinici za anesteziologiju i intenzivnu terapiju VMA u Beogradu. Svi bolesnici su bili praćeni od početka do kraja lečenja. Inicijalno je sprovedeno uzimanje anamnestičkih podataka, određivanje vitalnih znakova, biohemijske analize krvi i urina. Intraabdominalni pritisak (IAP) je meren indirektnom transvezikalnom metodom. Na osnovu vrednosti IAP pacijenti su podeljeni u dve eksperimentalne grupe: prvu grupu čine bolesnici sa IAP od 12-20mmHg (60 bolesnika), a drugu sa IAP preko 20 mmHg (20 bolesnika). Nakon 12 sati, u periodu od 2.- 5. dana i nakon 6. dana su ponovljene sve prethodno pomenute analize. Rezultati. Rezultati istraživanja su prikazani na 35 tabela i 13 grafikona. Najzastupljeniji etiološki faktor za nastanak AP je bila holelitijaza (41,2%), a najređi uzrok su bili tumori pankreasa (1%). Granična vrednost IAP pri kojoj postoji najveći procenat rizika za nastanak ACS je 14,5 mm Hg. Najveća verovatnoća pojave ACS postoji 6-og dana trajanja povišenih vrednosti IAP. Granična vrednost IAP-a pri kojoj nastaje nekroza je 15,5 mm Hg. Zaključak. Vrednost intraabdominalnog pritiska kod bolesnika sa AP ima veliki značaj jer se na osnovu njega blagovremeno može predvideti nastanak teškog oblika ovog oboljenja, proceniti stepen nekroze pankreasa i preduzeti intenzivne mere lečenja. Iz tog razloga je vrlo značajno meriti i pratiti vrednosti IAP koje se mogu koristiti i za određivanje rizika od smrtnog ishoda, čiji model izračunavanja smo i predstavili u našoj studiji ali efikasnost ovog modela trebalo bi testirati u budućim studijama.

The aim of this study was to investigate the influence of intra-abdominal pressure on the degree of pancreatic necrosis in patients with acute pancreatitis. Methods. The study included 80 patients, of both sexes, suffering from acute pancreatitis hospitalized in Clinic for General Surgery and the Clinic for Anesthesiology and Intensive Care of the Military Medical Academy in Belgrade. All patients were followed from the beginning to the end of treatment. Medical history, the determination of vital signs, biochemical analysis of blood and urine was taken at admission. Intra-abdominal pressure (IAP) was measured by indirect transvesical method. According to values of IAP, patients were divided into two experimental groups: the first group consisted of patients with IAP of 12- 20mmHg (60 patients) and another with IAP exceeding 20 mmHg (20 patients). After 12 hours, after period from 2. to 5. day and after 6. day all the above-mentioned analysis were repeated. Results. The research results are presented in 35 tables and 13 graphs. The most common etiological factor for the development of AP was cholelithiasis (41.2%) and the least common causes were tumors of the pancreas (1%). Limit value of IAP at which there was the highest percentage of the risk of ACS was 14.5 mm Hg. The highest probability of ACS, was at 6. day of increased IAP. Limit value of the IAP that provides the necrosis was 15.5 mm Hg. Conclusion. The value of intra-abdominal pressure in patients with AP has great significance. Based on this value, it can be opportunely predicted the occurrence of severe forms of the disease, assess the degree of pancreatic necrosis and undertake intensive treatment measures. For this reason it is very important to measure and monitor IAP values that can be used to determine the risk of death, whose calculation model we presented in our study, but the efficiency of this model should be tested in future studies.