INTRA-ABDOMINAL PRESSURE AS A PREDICTOR OF MICROCIRCULATORY DISORDER SEVERITY IN PATIENTS WITH ACUTE ADHESIVE SMALL BOWEL OBSTRUCTION
DOI:
https://doi.org/10.11603/2414-4533.2025.3.15624Keywords:
acute adhesive small bowel obstruction, intra-abdominal pressure, intra-abdominal hypertension, abdominal compartment syndrome, microcirculation, laser Doppler flowmetry, wavelet analysisAbstract
The aim of the work: to establish the correlation between the level of intra-abdominal pressure and the parameters of systemic microcirculation in patients with acute adhesive small bowel obstruction at different stages of the disease.
Materials and Methods. A total of 86 patients with acute adhesive small bowel obstruction (AASBO) were examined and divided into 3 groups: compensated stage (n=31), subcompensated stage (n=41), and decompensated stage (n=14). Intra-abdominal pressure (IAP) was measured using the transvesical method. The state of systemic microcirculation was assessed by Laser Doppler Flowmetry (LDF) with wavelet analysis of regulatory mechanisms. For comparison, analysis of variance (ANOVA) or its nonparametric analogue – the Kruskal – Wallis test, depending on the nature of the data distribution, was used. To establish the relationship between the level of ICP and microcirculation parameters, correlation analysis was used with the calculation of the Pearson correlation coefficient (r). Differences were considered statistically significant at the level of p<0.05.
Results. A strong direct correlation was established between the increase in IAP and the progressive suppression of active vasomotor regulation mechanisms (myogenic: r = -0.78; neurogenic: r = -0.71) and increased venous congestion (respiratory: r = 0.82; p<0.001). The progression of AASBO stages from compensation to decompensation was accompanied by an increase in mean IAP from (13.8±1.1) to (24.1±1.5) mmHg and a sequential depletion of microcirculatory regulatory reserves. Such a change in the state of microcirculation at different stages of GSKN, which we have studied, is fully consistent with modern ideas about the pathophysiology of ICH and abdominal compartment syndrome (ACS). The initial decrease in perfusion and activation of neurogenic tone in the compensation stage is a classic stress reaction of “centralization of blood circulation”, aimed at supporting vital organs. The body tries to adapt to the increasing pressure, mobilizing its regulatory reserves.
Conclusions. The level of IAP is a reliable and objective predictor of the severity of systemic microcirculatory disorders in AASBO. IAP monitoring should be included in the patient management protocol for early risk stratification and optimization of treatment tactics.
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