Abdominelles Kompartmentsyndrom

Zusammenfassung

Das abdominelle Kompartmentsyndrom (ACS) ist ein lebensbedrohliches Krankheitsbild, dessen Behandlungserfolg insbesondere von einer zeitnahen zielführenden Diagnostik und adäquaten Behandlungsprinzipien abhängt. Dieser CME-Beitrag beschreibt die pathophysiologischen Vorgänge beim ACS sowie das diagnostische und therapeutische Vorgehen bei diesen schwerst gefährdeten, intensivpflichtigen Patienten.

Abstract

Intra-abdominal hypertension and acute abdominal compartment syndrome are complex diseases that have a high morbidity and mortality and must be treated on an interdisciplinary basis in an intensive care unit. In order to be able to recognize and treat an ACS in good time, the intra-abdominal pressure should be measured every 4 – 6 hours in seriously ill patients with risk factors for an ACS. The measurement of the bladder pressure has proven to be valid and meaningful. The most effective method of pressure relief is the complete median laparotomy. Before surgical intervention, all conservative measures should be exhausted, since surgical decompression also has a high mortality and morbidity. Different approaches have been described for dealing with the open abdomen. Today, best experiences have been made with continuous negative pressure dressings and stepwise closure of the abdomen. After the abdomen is closed, complex incisional hernias occur, which require extensive surgeries to repair. Despite well-developed conservative and surgical methods of treating IAH and ACS, mortality and morbidity remain high.

Kernaussagen

• Der IAH und das akute ACS sind komplexe Erkrankungen, welche eine hohe Morbidität und Letalität aufweisen und auf einer Intensivstation interdisziplinär behandelt werden müssen.

• Um ein ACS rechtzeitig zu erkennen und behandeln zu können, sollte bei schwerkranken Patienten mit Risikofaktoren für ein ACS der intraabdominelle Druck alle 4 – 6 Stunden gemessen werden. Hier hat sich die Messung des Blasendrucks als valide und aussagekräftig gezeigt.

• Die effektivste Methode zur Druckentlastung ist die komplette mediane Laparotomie ggf. mit Anlage einer Vakuumversiegelung.

• Vor einer chirurgischen Intervention sollten alle konservativen Maßnahmen ausgeschöpft sein, da auch eine chirurgische Dekompression eine hohe Letalität und Morbidität aufweist.

• Im Weiteren müssen regelmäßige operative Wechsel der Versiegelung erfolgen, was einen hohen logistischen Aufwand erfordert.

• Nach Verschluss des Abdomens treten vermehrt komplexe Narbenhernien auf, welche wiederum durch ausgedehnte Operationen verschlossen werden müssen.

• Trotz weit entwickelter konservativer und operativer Methoden der Behandlung von IAH und ACS besteht weiterhin eine hohe Letalität und Morbidität.

Schlüsselwörter

intraabdomineller Hochdruck - abdominelles Kompartmentsyndrom - Diagnostik - Therapie

Key words

intra-abdominal hypertension, acute abdominal compartment syndrome, diagnostics, therapy

Publication History

Article published online:
28 May 2021

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