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Intensivmedizin up2date 2024; 20(04): 433-457
DOI: 10.1055/a-2337-4148
Operative Intensivmedizin

Das abdominelle Kompartmentsyndrom

Korrekte Diagnosestellung und konsequentes therapeutisches Vorgehen
Patricia Gerlach
,
Sebastian Schaaf 
,
Arnulf Willms 
,
Robert Schwab
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Das abdominelle Kompartmentsyndrom (ACS) ist eine schwerwiegende Komplikation intra- und extraabdomineller Erkrankungen und Traumata. Es tritt im klinischen Alltag regelmäßig auf, wird aber oft nicht erkannt, fehldiagnostiziert oder zu spät wahrgenommen. Verzögerte oder falsche Therapiemaßnahmen können deletäre Konsequenzen für den Patienten zur Folge haben.
Kernaussagen

  • Das Vorliegen eines abdominellen Kompartmentsyndroms (ACS) verschlechtert die Prognose und das Outcome chirurgischer und internistischer Intensivpatienten.

  • Die Risikofaktoren und auslösenden Krankheitsbilder sind vielfältig und umfassen insbesondere das Abdominaltrauma, retro- und intraabdominelle Blutungen, Peritonitis und Sepsis sowie die Massivtransfusionen und ausgeprägte Volumengabe.

  • Der Schlüssel einer erfolgreichen Therapie ist das rechtzeitige Erkennen und Therapieren der intraabdominellen Hypertension (IAH) und damit die Prävention des ACS.

  • Der liberale Einsatz der transvesikalen Blasendruckmessung unter vereinheitlichten Bedingungen stellt den diagnostischen Goldstandard dar.

  • Frühzeitig mit konservativen Therapiemaßnahmen der IAH beginnen.

  • Bei deren Versagen und manifestem ACS ist eine umgehende mediane Laparotomie zur Dekompression mit nachfolgender Laparostomaanlage die Therapie der Wahl.

  • Auch nach Laparostomaanlage IAP-Messungen (IAP = intraabdomineller Druck) fortsetzen, um rekurrentes ACS nicht zu übersehen.

  • Frühzeitigen Faszienverschluss anstreben, um Komplikationen zu vermeiden.

  • Die Vergleichbarkeit der meisten publizierten Studien ist aufgrund heterogener Kollektive und einer über lange Zeit uneinheitlichen ACS-Definition begrenzt.

Schlüsselwörter

intraabdomineller Druck - Bauchtrauma - intraabdominelle Hypertension - abdominelle Compliance - Intensivmedizin


Publication History

Article published online:
10 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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