Comprehensive assessment of the relationship between indicators of systemic intoxication and intra-abdominal pressure at the patients operated for peritonitis

Abstract

According  to the latest  statistical  data,  22% of patients  with emergency  abdominal  surgical  pathology  are  admitted  to medical institutions with signs of peritonitis. Despite modern methods of treatment and diagnosis, the mortality rate for this pathology remains at the same level and is approximately 18–29%, and in advanced forms can reach 75–90%. Recent studies show that in an unfavorable outcome of this pathological process, a leading role is given to a progressive increase in intraabdominal pressure (IAP). The relationship between the degree of endogenous intoxication and IAP values makes it possible to quickly assess the severity of the patient’s condition and the state of central hemodynamics without additional laboratory and instrumental studies. The aim of the study was to evaluate the indicators of systemic endogenous intoxication and intraabdominal  pressure and their relationship  in patients  with peritonitis in the pre- and postoperative  period. Material and methods. This work is based on a retrospective analysis of 74 patients operated on at the clinical bases of the Department of Hospital Surgery of the Moscow State Medical University named after A.I. Evdokimov for peritonitis from January to October 2022. The main causes of acute peritonitis were perforated ulcer of the stomach or duodenum, acute intestinal obstruction, thrombosis  of  mesenteric  vessels,  acute  pancreonecrosis,  complicated  colon  cancer.  The  average  age  of  patients  was 49 ± 2.5 years (34-75 years), 47 women, 27 men. The severity of peritonitis was assessed based on the degree of endotoxemia according to clinical and laboratory data. To monitor intra-abdominal  hypertension, IAP was measured. IAP measurement was performed on the operating table before surgery and in the early postoperative period. At the same time, compartment syndrome of the first degree was found in 51 (68%) patients, the second degree in 14 (19%) patients, and the third-fourth degree in 9 (13%) patients. For a comprehensive assessment of the patient’s condition and the effectiveness of the measures taken, the central hemodynamics was assessed and its relationship with the indicators of intra-abdominal pressure was evaluated. Comparative  analysis of central hemodynamics  manometry showed that with an increase in compartment  syndrome, there is a clear decrease in the performance of cardiac activity indicators, requiring urgent correction. The relationship between indicators of intra-abdominal  pressure and the duration of preoperative preparation was also evaluated. Conclusions. The relationship between the degree of endogenous intoxication and the degree of intra-abdominal pressure has been proven. With an increase in IAP values, the values of endogenous intoxication increase, which subsequently leads to the development of multiple organ failure. Even with the first degree of endogenous intoxication, a decrease in myocardial contractile ability is noted, which leads to the development of cardiovascular failure depending on the severity of the pathological process. The diagnosis of increased IAP syndrome has great practical value for detecting pathology and timely comprehensive treatment in the pre- and postoperative period.