Fisiopatologia e clinica della sindrome compartimentale addominale

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COD: 417-428 Categorie: ,

Franco Stagnitti, Stefano Toccaceli, Erasmo Spaziani, Giovanni Enrico Casciaro, Francesco Priore, Pietro Gammardella, Sergio Corelli, Massimo Diana, Luigi Persico Stella, Rossella Dandolo, Marcello De Pascalis, Annunziata Martellucci

Ann. Ital. Chir., 2006; 77: 417-428

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The abdominal compartment syndrome (ACS) is defined a situation of high degrade abdominal hypertension (IAH) with
clinicals signs of multiorganic dysfunction. It’s observed like in the intensive care,in particular surgycals and postraumatics,
there is ever a bigger frequence of complications presented by criticals patients. The various trials remark a changeable
incidence, but the common factor is characterized by a particular severity of scores. All the possibles mechanicals,
haemorragicals, infiammatories, and postraumatics causes act, but don’t enable the stability among abdominal content,
abdominal compliance and parietal tension. The initial triad of effects is constitued by the elevation of diaphragm and
the visceral and vascular compression; after this triad provoke a pathophysiologic system that, through various levels, bring
to a respiratory, renal and cardiocirculatory dysfunction and to a parietal, hepatic and intestinal ischemia with consequent
bacterical translation: sepsis and MOF. The Burch’s classification (1996) report four levels of gravity by the slight
(<15 mmHg) to the heavyest (>35 mmHg): the firsts two levels are of intensivistic competence and for the detention are
used conservatives metodics and pharmacological approach; instead in the lasts two levels it’s necessary to foresee a surgycal
treatment of laparotomy, washing and drainage with following temporary paret’s closure. The mortality is now very
elevated (29-62%) especially when it’s already established a multiorganical dysfunction; therefore it’s necessary forward its
appearance through the monitorization of abdominal pression (IAP) with the measurement of vescical pression in alls
criticals patients at the aim to treat immediately the firsts signs of IAH.

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