The Choice of Treatment Tactics in Patients with Severe Acute Pancreatitis Taking Into Account the Factor of Intra-Abdominal Hypertension

Relevance. Increased intra-abdominal pressure (IAP) in patients with severe acute pancreatitis (AP) is one of the triggers for the development of a functional organ failure, which leads to death. In this case, the favorable outcome of treatment of patients with severe AP is largely determined by early diagnosis and timely elimination of intra-abdominal hypertension (IAH). At the same time, there is no unified and agreed opinion on the principles and specific methods of eliminating the IAH syndrome in patients with severe AP today, which greatly complicates the choice of treatment strategy and tactics.Aim of study. To assess the role and clinical significance of IAP monitoring in patients with severe AP with various manifestations of organ dysfunction and, offer a set of therapeutic measures aimed at resolving intra-abdominal hypertension.Material and methods. The current study included 199 patients with severe AP, divided into two groups depending on the chosen treatment strategy. Group I included 107 patients where the diagnosis and treatment of the disease corresponded to generally accepted standards. Group II included 92 patients, where, in order to objectify the severity and prognosis of the course of AP, along with standard studies, IAP and APACHE II scale indicators were additionally monitored during treatment, and the severity of organ dysfunctions was assessed. In these patients the choice of medical tactics, including the use of conservative and surgical interventions, was made on a differentiated basis, based on the severity of the disease and the dynamics of the IAH.Results. The role and significance of IAP monitoring and APACHE II scale indicators in the treatment of patients with severe AP were determined. The use of a differentiated approach to the choice of treatment strategies for patients with AP considering the severity of the disease and severity of IAH syndrome results in reduced hospital mortality by 10.3% and reduced postoperative mortality by 11.4%.Conclusion. Monitoring of intra-abdominal pressure and APACHE II scale indices in conjunction with standard clinical and laboratory parameters allows patients to be clearly stratified according to the severity of acute pancreatitis, which helps optimize the choice of treatment tactics, including methods and timing of surgery, as well as the use of a set of effective therapeutic measures aimed at eliminating intra-abdominal hypertension

Выбор тактики лечения у больных тяжелым острым панкреатитом с учетом фактора внутрибрюшной гипертензии

Relevance. Increased intra-abdominal pressure (IAP) in patients with severe acute pancreatitis (AP) is one of the triggers for the development of a functional organ failure, which leads to death. In this case, the favorable outcome of treatment of patients with severe AP is largely determined by early diagnosis and timely elimination of intra-abdominal hypertension (IAH). At the same time, there is no unified and agreed opinion on the principles and specific methods of eliminating the IAH syndrome in patients with severe AP today, which greatly complicates the choice of treatment strategy and tactics.Aim of study. To assess the role and clinical significance of IAP monitoring in patients with severe AP with various manifestations of organ dysfunction and, offer a set of therapeutic measures aimed at resolving intra-abdominal hypertension.Material and methods. The current study included 199 patients with severe AP, divided into two groups depending on the chosen treatment strategy. Group I included 107 patients where the diagnosis and treatment of the disease corresponded to generally accepted standards. Group II included 92 patients, where, in order to objectify the severity and prognosis of the course of AP, along with standard studies, IAP and APACHE II scale indicators were additionally monitored during treatment, and the severity of organ dysfunctions was assessed. In these patients the choice of medical tactics, including the use of conservative and surgical interventions, was made on a differentiated basis, based on the severity of the disease and the dynamics of the IAH.Results. The role and significance of IAP monitoring and APACHE II scale indicators in the treatment of patients with severe AP were determined. The use of a differentiated approach to the choice of treatment strategies for patients with AP considering the severity of the disease and severity of IAH syndrome results in reduced hospital mortality by 10.3% and reduced postoperative mortality by 11.4%.Conclusion. Monitoring of intra-abdominal pressure and APACHE II scale indices in conjunction with standard clinical and laboratory parameters allows patients to be clearly stratified according to the severity of acute pancreatitis, which helps optimize the choice of treatment tactics, including methods and timing of surgery, as well as the use of a set of effective therapeutic measures aimed at eliminating intra-abdominal hypertension.Актуальность. Повышение внутрибрюшного давления (ВБД) у больных тяжелым острым панкреатитом (ОП) является одним из пусковых механизмов развития функциональной недостаточности органов, которая приводит к смертельному исходу. В этом случае благоприятный результат лечения больных тяжелым ОП в значительной мере определяется ранней диагностикой и своевременной ликвидацией внутрибрюшной гипертензии (ВБГ). Вместе с тем до настоящего времени не существует единого и согласованного мнения относительно принципов и конкретных способов устранения синдрома ВБГ у больных тяжелым ОП, что в значительной степени усложняет выбор тактики лечения.Цель. Оценить роль и клиническую значимость мониторинга ВБД у пациентов с тяжелым ОП с различными проявлениями дисфункции органов и на этой основе предложить комплекс лечебных мероприятий, направленных на разрешение интраабдоминальной гипертензии.Материал и методы. В настоящее исследование были включены 199 пациентов с тяжелым ОП, распределенных на две группы в зависимости от выбранной тактики лечения. В I группу вошли 107 больных, у которых диагностика и лечение заболевания соответствовали общепризнанным стандартам. Во II группу были включены 92 пациента, у которых с целью объективизации степени тяжести и прогноза течения ОП наряду с проведением стандартных исследований дополнительно в процессе лечения осуществлялось мониторирование ВБД и показателей шкалы APACHE II, а также оценивалась выраженность органных дисфункций. У данных больных выбор лечебной тактики, включая применение консервативных мероприятий и хирургических вмешательств, производили на дифференцированной основе, исходя из степени тяжести заболевания и динамики развития ВБГ.Результаты. Определены роль и значимость мониторирования ВБД и показателей шкалы APACHE II при лечении пациентов с тяжелым ОП. Показано, что применение дифференцированного подхода к выбору тактики лечения у больных с ОП с учетом степени тяжести заболевания и выраженности синдрома ВБГ приводит к снижению госпитальной летальности на 10,3% и послеоперационной летальности — на 11,4%.Заключение. Мониторирование величины внутрибрюшного давления и показателей шкалы APACHE II в совокупности со стандартными клинико-лабораторными параметрами позволяет четко стратифицировать пациентов по степени тяжести острого панкреатита, что способствует оптимизации выбора лечебной тактики, включая определение методов и сроков проведения оперативного вмешательства, а также применение комплекса действенных лечебных мероприятий, направленных на устранение интраабдоминальной гипертензии