Diuzheva T G, Shefer A V
Khirurgiia (Mosk). 2014(1):21-9.
The role of parapancreatitis in the intra-abdominal hypertension (IAH) progression in patients with severe acute pancreatitis with various forms of organs failure was studied. It was analyzed the treatment results of 63 patients with severe acute pancreatitis. The patients were divided into 4 groups: the first group (n=24) had not the signs of organs failure, the second group (n=15) - with symptoms of acute respiratory failure (ARF), the third group (n=11) - with a combination of ARF and acute cardiovascular failure (CVF) and the fourth group (n=13) - with a combination of ARF, CVF and acute renal failure. Intra-abdominal pressure (IAP) was measured at 1, 3, 5, 7- days from the beginning of the disease with calculation of the abdominal perfusion pressure and filtration gradient values. The prevalence evaluation of parapancreatitis was carried out on the basis of CT-data with bolus-dosing of the contrast agent, ultrasound, video laparoscopy as well as data obtained during operation and autopsy. It was defined that the intra-abdominal pressure (IAP) values was not significantly different and complied with intra-abdominal hypertension of the first grade in patients of the groups 1-3 at the first day. IAP was significantly higher and complied with intra-abdominal hypertension of the second grade in patients of the fourth group. IAP normalized to 5-7th days in patients of the first and the second groups. The patients of the third and the fourth groups had IAH of the second grade in the 7th day. There was reliable (p<0.01) average positive correlation (r=0.57) between the indications of IAH and the scale APACHE II. The patients with common parapancreatitis (n=39) had indications of IAP and APACHE II significantly higher than in patients with local forms of parapancreatitis (n=24; p<0.01). Common defeat of retroperitoneal fat determined persistent increase of IAP more than the presence of effusion in the abdominal cavity. In case of the first grade of IAH the mortality was 6.6%, the second grade - 37.5%, the third grade - 58.3% and the fourth grade - 80%. All died patients had a common parapancreatitis. The authors consider that the indications of IAP and APACHE II let to suppose an adverse outcome by the development of multiple organ failure in the early stages of the disease. Common parapancreatitis is the main feature of the persistent IAH (IAP increase during 5-7 days), which is an indication for early decompression operations on the abdominal wall.
研究了胰腺旁炎症在伴有各种器官衰竭形式的重症急性胰腺炎患者腹腔内高压（IAH）进展中的作用。分析了63例重症急性胰腺炎患者的治疗结果。患者分为4组：第一组（n = 24）无器官衰竭迹象，第二组（n = 15）有急性呼吸衰竭（ARF）症状，第三组（n = 11）有ARF和急性心血管衰竭（CVF）合并症，第四组（n = 13）有ARF、CVF和急性肾衰竭合并症。在疾病开始后的第1、3、5、7天测量腹腔内压力（IAP），并计算腹腔灌注压和滤过梯度值。基于使用造影剂团注的CT数据、超声、视频腹腔镜检查以及手术和尸检期间获得的数据，对胰腺旁炎症的患病率进行评估。结果确定，第1天第1 - 3组患者的腹腔内压力（IAP）值无显著差异，符合一级腹腔内高压。第四组患者的IAP显著更高，符合二级腹腔内高压。第一组和第二组患者在第5 - 7天IAP恢复正常。第三组和第四组患者在第7天有二级IAH。IAH指标与APACHE II评分之间存在可靠的（p<0.01）平均正相关（r = 0.57）。伴有普通型胰腺旁炎症的患者（n = 39）的IAP和APACHE II指标显著高于局部型胰腺旁炎症患者（n = 24；p<0.01）。腹膜后脂肪的广泛受累比腹腔积液更能决定IAP持续升高。在一级IAH时死亡率为6.6%，二级为37.5%，三级为58.3%，四级为80%。所有死亡患者均有普通型胰腺旁炎症。作者认为，IAP和APACHE II指标提示在疾病早期可能因多器官衰竭而出现不良结局。普通型胰腺旁炎症是持续性IAH（IAP在5 - 7天内升高）的主要特征，这是早期进行腹壁减压手术的指征。
