PREVALENCE AND PROGNOSIS OF ABDOMINAL COMPARTMENT SYNDROME IN PATIENTS WITH ACUTE PANCREATITIS

A formidable concomitant aggravating condition in acute pancreatitis is the development of abdominal compartment syndrome (ACS). Despite numerous publications on this topic, a large number of questions about the prevalence, effective methods for predicting the development of ACS and its treatment remain open and dictate the relevance of this issue. This complication can often be ignored due to the general ignorance of the peculiarities of its development and the peculiar difficulties of measuring IOP. The emergence of an effective, relatively simple method of predicting the development of hypertension in the practical arsenal of physicians is also an extremely important issue and a deterrent at the same time. Abdominal hypertension in acute pancreatitis is a trigger for the development of multiple organ failure. It is the systemic nature of elevat-ed ICP that causes the main effect on the macroorganism, which is manifested in a decrease in blood flow in the inferior vena cava system, reduction of visceral blood flow with ulcerogenic changes in the upper gastrointestinal tract. Objectives: to increase the effectiveness of treatment of acute pancreatitis by predicting and preventing the development of ACS. Methods. A retrospective analysis of surgical treatment of 76 patients with a diagnosis of acute pancreatitis on the basis of CNPE "URKH" UСС. The research was conducted in two stages. The first was to assess the prevalence of ACS among the subjects. In the second stage, the effectiveness of the ACS prognosis methodology and the proposed methods of preventing its development were evaluated. All patients with clinical manifestations of ACS, such as: swollen abdomen, unstable hemodynamics (blood pressure ≤ 90/60 mm Hg), respiratory failure (CDR ≥ 20), oliguria (daily urine ≤500 ml), among other diagnostic measures, ICP was measured using the intravesical method of indirect manometry. To predict the development of AKS, a technique with a load on the anterior abdominal wall was used. Intra-abdominal pressure (IAP) was measured using the intravesical method of indirect manometry. The set of therapeutic measures included the installation of a "search catheter" for the purpose of decompression of the abdominal cavity and conservative treatment. Results of the research. At the first stage, 7 pa-tients (IAP) had a higher 12 mm Hg, which is the upper limit of normal. The prevalence of ACS in our research was 9.21%. In the second stage, the research group with a positive test was pathogenetic complex treatment of ACS. Clinical signs of ACS were later detected in 46% of patients in group B, and in 6 of them ACS was confirmed by IAP measurement. In the research group, the above symptom complex on the background of treatment oc-curred in 2 patients. After re-measurement of IAP, one of them was diagnosed with ACS. Conclusions. Our proposed tactics make it pos-sible to predict and timely eliminate the progression of AKS. In the research group, for which we proposed a set of measures, confirmed ACS occurred in 4.1% of cases, which is significantly less than in the control (25%). The specificity of this method was 83, 3%, which is a good result, given the lack of alternative and effective methods for predicting the development of abdominal hypertension. An additional set of measures aimed at preventing the progression and elimination of existing hypertension along with the treatment of GP gives good results. In 95.6% of cases, the use of this treatment prevented the progression of ACS.