Intraabdominelle Hypertonie und abdominelles Kompartmentsyndrom – Basiswissen und anästhesiologische Aspekte

Zusammenfassung

Ein pathologischer Anstieg des intraabdominellen Drucks kann Funktionsstörungen der Niere, des Darms, der Lunge, des Herzens, aber auch einen erhöhten intrakraniellen Druck nach sich ziehen. Risikofaktoren und pathophysiologische Konsequenzen der intraabdominellen Hypertonie und des abdominellen Kompartmentsyndroms werden diskutiert. Es wird auf anästhesiologische Aspekte bei der Betreuung dieser meist schwer kranken Patienten eingegangen, wie Aspirationsgefahr, Kreislaufinsuffizienz und differenzierte maschinelle Beatmung.

Abstract

The increase in intra–abdominal pressure may be followed by a renal, gut, respiratory and cardial dysfunction and an increase in intra–cranial pressure. The review focuses risk factors and pathophysiological consequences of intra–abdominal hypertension and of abdominal compartment syndrome. Patients with intra–abdominal hypertension and abdominal compartment syndrome are critical ill and need special anesthesiological care due to risk of pulmonary aspiration, hemodynamic disturbances and difficult mechaninal ventilation.

intraabdomineller Druck - IAH - ACS - intraabdominelle Druckmessung

intraabdominal pressure - IAH - ACS - intra–abdominal pressure monitoring

Kernaussagen

• Eine prolongierte IAH kann zu einer Beeinflussung aller Vitalfunktionen führen.

• Folgende Konstellation sollte immer an ein ACS denken lassen: prall gespanntes Abdomen, rückläufige Diurese, Anstieg des Beatmungsdruckes und zunehmende hämodynamische Instabilität.

• Mittels meist indirekter Messverfahren zur Abschätzung des IAP können Risikopatienten identifiziert werden; die Palpation des Abdomens allein gilt als unzuverlässig.

• Ergebnisse wiederholter Messungen sind als Trend zu betrachten und sollten im Kontext mit beeinträchtigten kardiorespiratorischen Parametern interpretiert werden, da der Krankheitswert eines erhöhten IAP interindividuell unterschiedlich ist.

• Die Entscheidung über ein therapeutisches Vorgehen kann nicht allein an pathologischen Einzelmesswerten fixiert werden.

• Eine Dekompressionslaparotomie ist die lebensrettende Intervention bei therapierefraktärem ACS und kann in total intravenöser oder balancierter Anästhesie (ohne N₂O) erfolgen.

• Die Dekompressionslaparotomie hat ein abdominelles Reperfusionssyndrom zur Folge, kann von einer Kreislaufdekompensation begleitet sein, erfordert die Anpassung der Beatmungsparameter bei akut veränderter Atemmechanik und sollte eine postoperative Fortführung des IAP–Monitorings nach sich ziehen.

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