Форма документа : Стаття із журналу Шифр видання : Автор(и) : Олейник Г. А., Литовченко А. Н., Литовченко Е. Ю. Назва : Профилактика и лечение абдоминального компартмент-синдрома у больных с тяжелой термической травмой Місце публікування : Медицина неотложных состояний. - Київ, 2019. - N 1. - С. 53-60 (Шифр МУ104/2019/1) Примітки : Библиогр. в конце ст. MeSH-головна: ВНУТРИБРЮШНАЯ ГИПЕРТЕНЗИЯ -- INTRA-ABDOMINAL HYPERTENSION ОЖОГИ -- BURNS РЕГИДРАТАЦИОННАЯ ТЕРАПИЯ -- FLUID THERAPY Анотація: Внутрибрюшная гипертензия и абдоминальный компартмент-синдром тесно связаны с заболеваемостью и смертностью среди критически больных. Несмотря на достаточно большое количество специальных публикаций, посвященных данной проблеме, очень мало внимания уделяется абдоминальному компартмент-синдрому у больных с тяжелой термической травмой. В ряде исследований показано, что тяжелые ожоги являются фактором риска развития внутрибрюшной гипертензии. Большие объемы инфузионной терапии, используемые при лечении тяжелой ожоговой травмы, дополнительно предрасполагают пациентов к увеличению внутрибрюшного давления. Частота развития внутрибрюшной гипертензии у больных с тяжелой термической травмой составляет, по данным разных авторов, 57,8–82,6 %. После возникновения абдоминального компартмент-синдрома и связанной с ним полиорганной дисфункции летальность при обширных ожогах очень высока. Цель данной работы — проанализировать проблему развития абдоминальной гипертензии и абдоминального компартмент-синдрома у ожоговых больных, а также сделать выводы о профилактике данного состояния и улучшении результатов лечения пострадавших с тяжелой термической травмойAbdominal compartment syndrome (ACS) is defined as a sustained intra-abdominal pressure (IAP) 20 mmHg (with or without an abdominal perfusion pressure 60 mmHg) that is associated with new organ dysfunction/failure. Intra-abdominal hypertension (IAH) and ACS are associated with increased morbidity and mortality of patients. There are a lot of risk factors for IAH and ACS. Major burns are one of these factors. The generalized increase in capillary permeability that occurs in severe burn patients contributes to extensive edema formation and intra-peritoneal accumulation of “third-space” fluid. IAH/ACS should be suspected in all patients with severe burns. So, monitoring the IAP is the first step for establishing the importance of IAH/ACS in these patients. The use of excessive fluid resuscitation in combination with increased capillary permeability makes burned patients particularly vulnerable to the development of IAH, ACS, cardiovascular, respiratory, and renal system dysfunction. Key to the prevention of ACS is the early recognition and treatment of IAH. Resuscitation in the very first hours after a burn is of great importance in the treatment of severe burn shock. The choice of resuscitation fluid in severe burned patients also may have a clinical importance. For patients with severe burn injury, it is necessary to strive to restore microcirculation in the shortest possible time, using the minimum amount of fluid necessary to maintain the physiological functions of the body. Now novel resuscitation strategies to avoid IAH/ACS in burned patients are evolving. Recent evidence supports the use of hypertonic sodium chloride solution and colloids that can decrease overall fluid volume resuscitation. The use of saline only can be limited in cases where dehydration does not reach the stage of reducing the volume of circulating blood. If dehydration progresses to the stage of intravascular space reduction, then early administration of colloids is necessary. And later, saline can be administered to rehydrate the interstitial space. There is also growing evidence that vitamin C supplementation in the early post-burn period seems to decrease the required fluid volumes. Non-operative and percutaneous interventions may be used before surgical decompression. Nasogastric decompression, the use of neuromuscular blocking agents, prokinetic agents, enemas, or colonic decompression, the removal of excess fluid by percutaneous drainage, or by a combination of continuous veno-venous hemofiltration with ultrafiltration and/or diuretics are simple and possibly effective tools to reduce IAP. Circumferential abdominal burn eschars might also lead to ACS. Urgent decompressive escharotomy of the abdominal wall is a safe surgical procedure that provides rapid decrease of IAP. It improves ventilation, hemodynamic parameters, oxygen metabolism and can decrease morbidity and mortality. The open abdomen in trauma and non-trauma patients has been proposed to be effective in treating ACS if there are no other treatment options. However, it is necessary to pay a great attention to the high mortality with an open abdomen in patients with severe burns. Therefore, its use should be considered as the last step of despair, when other methods cannot be used. IAH is a common complication in patients with severe burn injuries. The development of ACS in these patients is associated with high mortality. Prevention, early detection and proper treatment of IAH will help avoid this usually fatal complication. The use of the minimum amount of solutions required to restore circulating blood volume and microcirculation helps prevent IAH and ACS in patients with severe burn injury Дод.точки доступу: Литовченко, А. Н. Литовченко, Е. Ю.