Проучване на интра-абдоминалната хипертензия и възможностите за повлияването и при пациенти в интензивно отделение
Intra-abdominal hypertension in ICU – prospective epidemiological study
коремна кухина; интра-абдоминална хипертензия; диагностика; болести
The aim of this prospective study is to examine the frequency and the severity of intra-abdominal hypertension (IAH) and the opportunities for nonsurgical management in intensive care unit. To realize this purpose we set the following tasks: 1. To examine the available data concerning IAP for measurement in clinical settings, to create reproducible and reliable method for intermittent measurement of IAP. 2. To the validated proposed by a parallel comparison of the values with those from the standard medical equipment for intraoperative monitoring of IAP. 3. To study factors caused by the investigator which affect negatively the accuracy of the proposed method. 4. To the frequency and the severity of intra-abdominal hypertension in ICU patients 5. To determined the influence of nondepolarizing muscle relaxants and analgesia upon IAP. A closed system for intravesical intermittent measurement of IAP has been constructed. The method was validated in a study of 30 patients, who had a laparoscopic cholecystectomy by using Bland Altman plot as WSACS recommended. The effect of installed intravesical volume upon IAP has been studied. It was established that the introduction of volumes more than 50 ml in the bladder for intravesical measurement of IAP through fluid filled monitoring system with external transduser will lead to falsely increased values of IAP. This will result in wrong clinical decisions.The effect of patient’s position on IAP was also explored. From the statistical analysis (Repeated Measures ANOVA and Dunnett test) a significant difference was found between the results from measuring IAP in supine position and HOB 30°, 45° and lateral position. Patients in semirecumbent position with 30° or 45° HOB elevation IAP is between 4-10mmHg higher than in supine position.The frequency and the severity of IAH were examined in the period from June 2009 to December 2012 among 240 ICU patients separated in 3 groups (patients undergo elective, emergency surgery and medical patients) in University Hospital, Stara Zagora. In the elective group of patients there is 12,5% IAH, while in the emergency group IAP is 43.75%, and in the medical patients it is 42.5%.There is no statistical significant difference in the frequency of IAH among the mixed population of patients we examined and those studied by other authors with the same type of population.We found out that the use of nondepolarizing muscle relaxants leads to significant reduction in IAH which may have a beneficial effect on the patients with IAH. In patients with first and second degree of abdominal hypertension which we examined, adequate analgesia results in reduction in IAP, but there is an insignificant change of IAP in patients with higher degree of IAH The standardized measurement of IAP is fundamental for defining intra-abdominal hypertension and Abdominal compartment syndrome. Our point of view is that before there are indications for a surgical decompression, less invasive treatment options should be optimized.