Critical Care Unit and Gastroenterology Section, Department of Internal Medicine, Clinical Hospital, University of Chile, Santiago 8380456, Chile.
Medicina (Kaunas). 2022 Jun 10;58(6):785. doi: 10.3390/medicina58060785.
Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was reviewed, as well as the authors' own experiences, concerning the clinical importance of IAH and its treatment in SAP. The principal observations confirmed that IAH is a frequent consequence of SAP but is practically absent in mild disease. Common manifestations of AP such as pain, abdominal distension, and paralytic ileus contribute to increased abdominal pressure, as well as fluid loss in third space and aggressive fluid replacement therapy. A severe increase in IAP can evolve to abdominal compartment syndrome and new onset organ failure. Conservative measures are useful, but invasive interventions are necessary in several cases. Percutaneous drainage of major collections is preferred when possible, but open decompressive laparotomy is the final possibility in some cases in order to definitively reduce abdominal pressure. Intra-abdominal pressure should be measured in all SAP cases that worsen despite adequate treatment in critical care units. Conservative measures must be introduced to treat IAH, including negative fluid balance, digestive decompression by gastric-rectal tube, and prokinetics, including neostigmine. In the case of insufficient responses to these measures, minimally invasive interventions should be preferred.
患有重症急性胰腺炎（SAP）的患者会出现并发症和器官衰竭，需要在重症监护病房接受治疗。这些胰外并发症决定了疾病的临床转归。腹腔内高压（IAH）会使 SAP 的预后恶化。本文回顾了相关的近期文献，以及作者关于 SAP 中 IAH 的临床重要性及其治疗的经验。主要观察结果证实，IAH 是 SAP 的常见后果，但在轻度疾病中实际上不存在。AP 的常见表现，如疼痛、腹胀和麻痹性肠梗阻，会导致腹内压升高，以及第三间隙液体丢失和积极的液体替代治疗。严重的 IAP 增加可发展为腹腔间隔室综合征和新发器官衰竭。保守措施是有用的，但在某些情况下需要侵入性干预。如果可能，应首选经皮引流主要积液，但在某些情况下，为了有效地降低腹内压，开腹减压术是最后的选择。在所有 SAP 病例中，如果在重症监护病房接受充分治疗后病情恶化，都应测量腹内压。必须采用保守措施来治疗 IAH，包括负液体平衡、胃-直肠管的消化减压以及包括新斯的明在内的动力药物。如果对这些措施的反应不足，应优先考虑微创干预。
