Effect of increased intra-abdominal pressure on liver function and clinical course after major abdominal surgery

Intraabdominalni tlak (IAP, prema engl. Intra-abdominal Pressure) često je povećan u kritično bolesnih te nakon abdominalnih operacija kako hitnih tako i elektivnih. Normalna vrijednost IAP-a je 0 – 7 mmHg, a raspon IAP-a u kritično bolesnih kreće se između 5 – 7 mmHg. Povećani IAP može dovesti do intraabdominalne hipertenzije (IAH, prema engl. Intra-abdominal Hyperetnsion) i/ili abdominalnog sindroma odjeljka (ACS, prema engl. Abdominal Compartment Syndrome). Etiologija povećanja intraabdominalnog tlaka može biti sam operativni zahvat, infekcija, politransfuzija, mehanička ventilacija, gastropareza, ileus, trauma i sl. U ovom istraži-vanju analizirao utjecaj IAH na funkciju jetre kao splanhničkog organa nakon abdominalne ne-jetrene kirurgije metodom brzine plazmatskog nestanaka indocijanin zelene boje (ICG-PDR, prema engl. Indocyanine Green Plasma Disappearance Rate), i ICG R15 (stopa zadržavanja nakon 15 minuta, prema engl. Retention rate) te korelaciju IAH sa standardnim testovima jetrene funkcije (AST, ALT, bilirubin, albumini, PV), kliničkim bodovnim sustavima (APACHE II, SOFA, SAPS II, MODS i SIRS) i hemodinamskim pokazateljima (doprema kisika, minutni volumen, serumski laktati, APP). Pratio se i ishod bolesnika. Studija je pokazala korelaciju IAP-a i kliničkih bodovnih sustava, laktata u serumu, te pokazatelja jetrene funkcije (AST, ALT, bilirubin, ICG R15) te korelaciju APP-a s kliničkim bodovnim sustavima, osim MODS-a, korelaciju s laktatima u serumu, ICG-PDR i ICG R15. Nađena je i statistički značajna korelacija između ICG-PDR, IAP-a, APP-a i ishoda bolesnika, što može sugerirati da ICG-PDR i ICG R15 testovi mogu biti koristan dijagnostički alat u kliničkoj procjeni utjecaja IAH na perfuziju splanhnikusa, napose jetre u bolesnika nakon velikih, ne-jetrenih trbušnih operacija. U slici 25. na stranici 75 naznačeni su mjesta i elementi etiopatogenetskog mreženja procesa koji izravno pokazuju, odnosno, posredno doprinose rezultati ove disertacije.Intra-abdominal pressure (IAP) is often elevated in critical illness and after abdominal surgery. Increased IAP (> 12 mmHg) can lead to intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Etiology of elevated IAP can be abdominal operation, infection, resuscitation, mechanical ventilation, ileus, trauma, etc. The aim of this study was to assess liver function by measuring plasma disappearance rate of indocyanine green dye (ICG-PDR) and retention rate of ICG after 15 minutes (ICG R15) in patients with IAH after major abdominal surgery. The correlation of IAP and abdominal perfusion pressure (APP) with classic liver function tests (AST, ALT, bilirubin, albumin, PT), clinical scoring systems (APACHE II, SAPS, SOFA, SIRS and MODS), oxygen delivery (DO2), cardiac index (CI) and serum lactate were analysed too. Significant correlation was finding between IAP and clinical scoring systems, serum lactate, AST, ALT, bilirubin and ICG R15. Also, APP correlates with clinical scoring systems, serum lactate, ICG-PDR and ICG.R15. Statistically significant correlation was finding between IAP, APP, ICG-PDR and survival. The results suggest that ICG-PDR and ICG R15 could be useful dynamic tests for evaluation of complex liver function after major abdominal surgery in patients with IAH. Scientific results of this thesis are outlined in figure 25 on page 75 and located within the etiopathogenic pathways network