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Intensivmedizin up2date 2013; 09(02): 141-157
DOI: 10.1055/s-0032-1326211
Operative Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Abdominelles Kompartmentsyndrom

Kristjan Ukegjini
,
Michel Adamina
,
Marcel Zadnikar
,
Ignazio Tarantino
Further Information

Publication History

Publication Date:
15 May 2013 (online)

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Kernaussagen

Pathophysiologie

  • Der normale intraabdominelle Druck beträgt etwa 5 mmHg.

  • Liegt der intraabdominelle Druck konstant über 12 mmHg, spricht man von einer intraabdominellen Hypertonie.

  • Liegt der intraabdominelle Druck über 20 mmHg und besteht gleichzeitig eine Organdysfunktion, spricht man von einem abdominellen Kompartmentsyndrom.

  • Teufelskreis: Ein steigender intraabdomineller Druck führt zur Kompression der intraabdominellen und retroperitonealen Gefäße, was zur venösen Stase mit anschließender Flüssigkeitssequestration und Beeinträchtigung der arteriellen Perfusion führt.

  • Die intraabdominelle Hypertonie ist ein auf der Intensivstation häufiges, aber auch oft übersehenes Krankheitsbild, das ohne Prodomi auftreten kann.

  • Die Letalität des abdominellen Kompartmentsyndroms kann bis zu 60 % betragen.

Diagnostik

  • Erste manifeste Organdysfunktion ist eine Einschränkung der Nierenfunktion.

  • Standard ist die indirekte Messung des Blasendrucks über einen Katheter. Ein alternatives Messverfahren ist die Messung des Mageninnendrucks.

Therapie

  • Eine frühzeitige Diagnose und adäquate therapeutische Intervention senken die Morbidität und Mortalität. Die Ziele der Interventionen sind eine Senkung des intraabdominellen Drucks und ein abdomineller Perfusionsdruck von 50 – 60 mmHg.

  • Konservative Maßnahmen: u. a. Muskelrelaxation, Prokinetika und rektale Dekompression, Anhebung des kolloidosmotischen Drucks in Kombination mit Diuretika oder Nierenersatzverfahren, Drainagen.

  • Operative Maßnahmen: dekompressive Laparotomie und Anlage eines Laparostomas, temporärer Bauchdeckenverschluss mit OPSITE-Folie, synthetischem Netz oder Unterdrucktherapie.

Ergänzendes Material

 

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