Инфузионная терапия

Она необходима для коррекции ОЦК, особенно перед декомпрессией. Наличие и степень гиповолемии у больных СБП обычными методами оценить практически невозможно (см. выше). Рекомендуется инфузия кристаллоидных растворов, особенно перед лапаротомией. Следует отметить, что инфузионная терапия для коррекции гиповолемии полезна и необходима только на первых этапах лечения перед подготовкой больного к операции. Если декомпрессия не выполняется, массивные инфузии усиливают отек ишемизированного кишечника и еще больше увеличивают ВБГ [12;58].

Диурез восстанавливается после декомпрессии и мало поддается консервативным мероприятиям, если операция задерживается.

Практические рекомендации (c cокращениями, [50])

1.СБП приводит к нарушению абсолютно всех жизненно важных функций и является смертельной патологией, требующей своевременной диагностики и немедленного лечения

2. Частота ВБГ (>12 мм Hg) в блоках интенсивной терапии колеблется от 20 процентов у терапевтических больных до 30 процентов у хирургических. ВБД после неосложненных операций на животе нередко повышается до 3-15 мм Hg.

Доказан риск развития СБП у больных в критическом состоянии, получивших массивную (>10-12 литров) инфузионную терапию (ожоги).

3. ВБД необходимо измерять в динамике у всех больных с подозрением на ВБГ. В подавляющем большинстве случаев ВБД измеряют в мочевом пузыре. Если по каким-то причинам это невозможно, измеряют внутрижелудочное давление или давление в нижней полой вене.

4. Единственной эффективным лечением СБП является экстренная хирургическая декомпрессия. Величина ВБГ, приводящая к развитию СБП бывает разной, при ее значении выше 30-35 мм Hg декомпрессия должна выполняться всем больным.

5. Обычные показатели гемодинамики искажаются внутрибрюшной гипертензией и не должны использоваться для оценки состояния сердечно-сосудистой системы и волемического статуса больного. Желудочная тонометрия как показатель кровотока внутренних органов, хорошо коррелирует с ВБГ и может использоваться для оценки тяжести синдрома.

7. Инфузионная терапия и ИВЛ оказываются эффективными только на этапе подготовки больного к декомпрессии. Избыточная инфузия для коррекции гиповолемии усугубляет отек кишечника и ВБГ. Высокое ПДКВ, необходимое этим больным для нормального газообмена, также увеличивает ВБГ и ее последствия.

8. Прогнозируемые осложнения сразу после декомпресии: гипотония, асистолия, ТЭЛА.

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