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Khirurgii

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Year 2017 Vol. 25 No 2

GENERAL & SPECIAL SURGERY

B.M. BELIK1, G.M. CHIRKINYAN1, A.I. MASLOV1, D.V. MAREEV2

CLINICAL SIGNIFICANCE OF INTRA-ABDOMINAL PRESSURE ELEVATION IN PATIENTS WITH SEVERE ACUTE PANCREATITIS

FSBEE HE "Rostov State Medical University"1,
MBEHC "Municipal Hospital N1 named after N.A. Semashko"2
Rostov,
The Russian Federation

Objective. To determine the clinical significance of intra-abdominal pressure (IAP) in forecasting of the severe acute pancreatitis (AP), in evaluating the effectiveness of the perfomance of intensive therapy and in substantiating of the conduction of early sanitational and decompression surgery.
Methods. The analysis of treatment results of patients (n=76) with severe AP has been performed. Depending on the AP severity, all patients were divided into four groups. In 26 (34,2%) patients the organ dysfunctions were transitory (group 1), in 18 (23,7%) – functional failure of one organ was registered (group 2), in 15 (19,7%) – of two organs (group 3) and in 17 (22,4%) – of three or more organs (group 4). Within the 1-7th days from the disease onset, patients’ intra-abdominal pressure (IAP) was monitored with the calculation of abdominal perfusion pressure and filtration gradient as well as evaluating the severity of the patients’ condition by APACHE II scores. Prevalence of retroperitoneal necrosis was estimated according to US data, a bolus contrast-enhanced computed tomography and the information obtained during the operation and autopsy.
Results. It has been found out that IAP level of patients (1-2 groups) corresponded to the 1st degree of the intra-abdominal hypertension (IAH) with a reduction of this value by the 5-7th days. In patients of the 3-4th groups remained the 2-3rd degree of IAH by the 5-7th days. A direct correlation between the values of IAP and APACHE II scores was noted. The values of IAP and APACHE II scores in patients with the generalized retroperitoneal necrosis were significantly higher than in patients with limited forms of retroperitoneal necrosis. Lethal outcome occurred in 17 (22,4%) out of 76 patients with severe AP. In the 1st group of patients there were no lethal outcomes. In the 2nd group mortality was 11,1%, in the 3rd group – 33,3%, in the 4th group – 58,8%.
Conclusion. The level of IAP objectively represents the severity of AP, allows predicting the course and outcome of the disease and evaluating the effectiveness of intensive therapy and substantiating the performance of early sanitational and decompression surgery.

Keywords: severe acute pancreatitis, intra-abdominal pressure, intra-abdominal hypertension, multiorgan failure, retroperitoneal necrosis, mortality, sanitational and decompression surgery
p. 124-130 of the original issue
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Address for correspondence:
344000, Russian Federation,
Rostov-on-Don, Voroshilov pr., 105,
MBUZ "City Hospital N1 named after N.A. Semashko",
Department of general surgery.
tel.: 8-904-500-64-42
e-mail: bbelik@yandex.ru
Boris M. Belik
Information about the authors:
Belik B.M. MD, Head of department of general surgery, FSBEE HE "Rostov State Medical University".
Chirkinyan G.M. Post-graduate student of department of general surgery, FSBEE HE "Rostov State Medical University".
Maslov A.I. PhD, Ass. Professor of department of general surgery, FSBEE HE "Rostov State Medical University". D.V.
Mareev D.V. PhD, physician- surgeon of surgical department , MBEHC “Municipal Hospital N1 named after N.A. Semashko” Rostov-on-Don
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