Intra-abdominal hypertension syndrome. Method for reducing intra-abdominal pressure in obesity in abdominal surgery

Owners of patent RU 2444306:

The invention relates to medicine and can be used to reduce intra-abdominal pressure in obesity in abdominal surgery. Simultaneously with the main operation, resection of 2/3 of the stomach, cholecystectomy, appendectomy are performed, an anastomosis of the ileum with the stomach is performed using compression implants, and an interintestinal anastomosis is formed at a distance of 10% of the total length of the small intestine from the ileocecal angle. The method provides a sustainable reduction in body weight. 2 ill., 1 tab.

The invention relates to the field of medicine and can be used in abdominal surgery.

Increased intra-abdominal pressure is one of the factors that adversely affects the healing of postoperative wounds and one of the leading causes of postoperative complications. Most often, an increase in intra-abdominal pressure is observed in obesity. In obese patients, the load on the tissues of the abdominal wall increases significantly as a result of increased intra-abdominal pressure, the processes of wound consolidation slow down, the muscles of the abdominal wall atrophy and become flabby [A.D. Timoshin, A.V. Yurasov, A.L. Shestakov. Surgical treatment of inguinal and postoperative hernias of the abdominal wall // Triad-X, 2003. - 144 p.]. With increased intra-abdominal pressure, phenomena of chronic cardiopulmonary failure occur, which leads to disruption of the blood supply to tissues, including in the surgical area. Due to high pressure during and after surgery, interposition of fatty tissue between the sutures occurs, adaptation of the layers of the abdominal wall when suturing wounds is difficult, and the reparative processes of the postoperative wound are disrupted [Surgical treatment of patients with postoperative ventral hernias / V.V. Plechev, P.G. Kornilaev, P.P. Shavaleev. // Ufa 2000. - 152 p.]. In obese patients, the recurrence rate of large and giant postoperative ventral hernias reaches 64.6%. [N.K. Tarasova. Surgical treatment of postoperative ventral hernias in obese patients / N.K. Tarasova // Bulletin of Herniology, M., 2008. - P.126-131].

There are known methods for reducing intra-abdominal pressure as a result of sewing in mesh implants [V.P. Sazhin et al. // Surgery. - 2009. - No. 7. - P.4-6; V.N. Egiev et al. / Tension-free hernioplasty in the treatment of postoperative ventral hernias // Surgery, 2002. - No. 6. - P.18-22]. When performing such operations, one of the leading causes of increased intra-abdominal pressure - obesity - is not eliminated.

Methods for balancing increased intra-abdominal pressure with excess external pressure are described. Before planned operations for large hernias, a long-term (from 2 weeks to 2 months) adaptation of the patient to the postoperative increase in intra-abdominal pressure is carried out. For this purpose, dense bandages, fabric tapes, etc. are used [V.V. Zhebrovsky, M.T. Elbashir // Surgery of abdominal hernias and events. Business-Inform, Simferopol, 2002. - 441 pp.; N.V. Voskresensky, S.D. Gorelik // Surgery of abdominal wall hernias. M., 1965. - 201 p.]. In the postoperative period, to balance increased intra-abdominal pressure, the use of bandages is also recommended, up to 3-4 months [N.V. Voskresensky, S.L. Gorelik. // Surgery of abdominal wall hernias. M., 1965. - 201 p.]. As a result of corrective external compression, the respiratory and cardiovascular function of the body indirectly worsens, which can lead to corresponding complications.

The most promising method of reducing intra-abdominal pressure is to eliminate the leading factor, obesity, which affects the outcome of the operation. In abdominal surgery, to reduce fat deposits in the abdominal cavity, preoperative preparation is used, aimed at reducing the patient’s body weight through a course of dietary therapy (prescribed slag-free diet, activated charcoal, laxatives, cleansing enemas). [V.I. Belokonev et al. // Pathogenesis and surgical treatment of postoperative ventral hernias. Samara, 2005. - 183 p.]. 15-20 days before admission to the clinic, bread, meat, potatoes, fats and high-calorie cereals are excluded from the patient’s diet. Low-fat meat broths, yogurt, kefir, jelly, pureed soups, plant foods, tea are allowed. 5-7 days before the operation, already in a hospital setting, the patient is given cleansing enemas every morning and evening. The patient’s body weight during the period of preoperative preparation should decrease by 10-12 kg [V.V. Zhebrovsky, M.T. Elbashir // Surgery of abdominal hernias and events. Business Inform. - Simferopol, 2002. - 441 p.]. We chose this method as a prototype.

It should be noted that practice usually combines nutritional therapy, bowel preparation and adaptation of the patient to increased pressure through bandages, which makes preoperative preparation lengthy and complex.

The purpose of the present invention is to develop a method for eliminating one of the leading factors of obesity, which influences the formation of high intra-abdominal pressure.

The technical result is simple, does not require large material costs, based on performing an additional operation aimed at reducing body weight during the main operation during abdominal surgery.

The technical result is achieved by the fact that according to the invention, simultaneously with the main operation, resection of 2/3 of the stomach, cholecystectomy, appendectomy are performed, an anastomosis of the ileum with the stomach is carried out using compression implants and at a distance of 10% of the total length of the small intestine, from the ileocecal angle is formed interintestinal anastomosis.

The essence of the method is achieved by the fact that there is a persistent decrease in intra-abdominal pressure due to a decrease in body weight as a result of a decrease in the absorption of fats and carbohydrates, the asepsis of operations increases, and the risk of postoperative complications, and above all, purulent ones, is reduced.

The proposed method is carried out as follows: resection of 2/3 of the stomach, cholecystectomy, appendectomy are performed, an anastomosis of the ileum with the stomach is carried out using compression implants, and an interintestinal anastomosis is formed at a distance of 10% of the total length of the small intestine from the ileocecal angle. Then the main abdominal surgery is performed.

The method is illustrated graphically. Figure 1 shows a diagram of the biliopancreatic bypass operation, where 1 is the stomach; 2 - part of the stomach to be removed; 3 - gallbladder; 4 - appendix. The organs to be removed are indicated in black. Figure 2 shows a diagram of the formation of interintestinal and gastrointestinal anastomoses, where 5 is the stump of the stomach after resection; 6 - ileum; 7 - anastomosis of the ileum with the stomach; 8 - interintestinal anastomosis.

In the analyzed literature, this set of distinctive features was not found and this set does not follow clearly from the prior art for a specialist.

Practical examples

Patient V., 40 years old, was admitted to the surgical department of the Tyumen Regional Clinical Hospital with a diagnosis of “Postoperative giant ventral hernia.” Concomitant diagnosis: Morbid obesity (height 183 cm, weight 217 kg. Body mass index 64.8). Arterial hypertension grade 3, grade 2, risk 2. Hernial protrusion - since 2002. Hernial protrusion measuring 30x20 cm occupies the umbilical region and hypogastrium.

On August 30, 2007, the operation was performed. Anesthesia: epidural anesthesia in combination with inhalational anesthesia with isoflurane. The first stage of the operation (additional). Resection of 2/3 of the stomach, cholecystectomy, appendectomy, and, using compression implants, were performed; a gastrointestinal anastomosis and an interintestinal anastomosis from the ileocecal angle were formed at a distance of 10% of the total length of the small intestine.

The second stage of the operation (main). Hernioplasty with a polypropylene mesh graft of the abdominal wall defect was performed using a technique with a preperitoneal placement of the prosthesis. Hernial orifice 30×25 cm. The elements of the hernial sac and the peritoneum were sutured with a continuous wrapping suture using non-absorbable suture material. A prosthesis of 30×30 cm was cut out; when straightened, its edges went under the aponeurosis by 4-5 cm. Next, the prepared allograft was fixed with U-shaped sutures, grasping the edges of the prosthesis and piercing the abdominal wall, retreating from the edge of the wound by 5 cm. The distance between the sutures is 2 see. Suturing of the anterior abdominal wall is performed in layers.

The postoperative period proceeded without complications. At discharge at the control weighing, the weight was 209 kg. Body mass index 56.4. The patient was observed for 3 years. After 6 months: Weight 173 kg (Body mass index - 48.6). After 1 year: Weight 149 kg (Body mass index 44.5). After 2 years: Weight 136 kg (Body mass index 40.6). The level of intra-abdominal pressure before surgery (in a standing position) was 50.7 mm Hg. after 12 months; after surgery - decreased to 33 mm Hg. There is no recurrence of the hernia.

Patient K., 42 years old, was admitted to the surgical department of the Tyumen Regional Clinical Hospital with a diagnosis of “Postoperative giant recurrent ventral hernia.” Associated diagnosis: Morbid obesity. Height 175 cm. Weight 157 kg. Body mass index 56.4. In 1998, the patient was operated on for a penetrating stab wound to the abdominal organs. In 1999, 2000, 2006 - operations for recurrent postoperative hernia, incl. using polypropylene mesh. On examination: a hernial protrusion measuring 25x30 cm, occupying the umbilical and epigastric regions.

On October 15, 2008, the operation was performed. The first stage of the operation (additional). We performed resection of 2/3 of the stomach, cholecystectomy, appendectomy, anastomosis of the ileum with the stomach, and an interintestinal anastomosis was performed using compression implants during the operation. The interintestinal anastomosis is applied from the ileocecal angle at a distance equal to 10% of the total length of the small intestine.

The second stage of the operation (main). Hernioplasty with a polypropylene mesh graft of the abdominal wall defect was performed using a technique with a preperitoneal placement of the prosthesis. Hernial orifice measuring 30×25 cm. A prosthesis of 30×30 cm was cut out; when straightened, its edges went under the aponeurosis by 4-5 cm. Next, the prepared allograft was fixed with U-shaped sutures, grasping the edges of the prosthesis and piercing the abdominal wall, moving away from the edge of the wound by 5 cm. The distance between the sutures is 2 cm. The postoperative period was without complications. On the 9th day the patient was discharged from the hospital. At check-weighing at discharge - weight 151 kg. The patient was followed for 2 years. After 6 months: Weight 114 kg (Body mass index - 37.2). After 1 year: Weight 100 kg (Body mass index 32.6). After 2 years: Weight 93 kg (Body mass index 30.3). The level of intra-abdominal pressure before surgery (in a standing position) was 49 mm Hg, 12 months after surgery it decreased to 37 mm Hg. There is no recurrence of the hernia.

Patient V., 47 years old, was admitted to the surgical department of the Tyumen Regional Clinical Hospital with a diagnosis of “Postoperative giant ventral hernia.” Concomitant diagnosis: Morbid obesity (height 162 cm, weight 119 kg. Body mass index 45.3). In 2004, an operation was performed - cholecystectomy. After 1 month, a hernial protrusion appeared in the area of the postoperative scar. On examination: the size of the hernial orifice is 25×15 cm.

05.06.09. The operation was performed: The first stage of the operation (additional). We performed resection of 2/3 of the stomach, cholecystectomy, appendectomy, anastomosis of the ileum with the stomach and an interintestinal anastomosis, using a compression implant “with shape memory” made of titanium nickelide TN-10 during the operation. The interintestinal anastomosis is applied from the ileocecal angle at a distance of 10% of the total length of the small intestine.

The second stage of the operation (main). Hernia repair, repair of the defect with polypropylene mesh according to the method described above. The postoperative period proceeded without complications. After removal of the drains on the 7th day, the patient was discharged from the hospital. At check-weighing at discharge - weight 118 kg. The patient was observed for 1 year. After 6 months: Weight 97 kg (Body mass index - 36.9). After 1 year: Weight 89 kg (Body mass index 33.9). The level of intra-abdominal pressure before surgery (in a standing position) was 45 mm Hg, 12 months after surgery it decreased to 34 mm Hg. There is no recurrence of the hernia.

The proposed method was tested on the basis of the regional clinical hospital in Tyumen. 32 operations were performed. The simplicity and effectiveness of the proposed method, which ensures a reliable reduction in intra-abdominal pressure as a result of surgical intervention aimed at reducing the patient’s body weight, reducing the volume of contents in the abdominal cavity, reducing the absorption of fats and carbohydrates, made it possible to reduce the volume of fat deposits in patients, which made it possible for patients with morbid obesity during abdominal operations to increase the asepsis of operations, reduce the risk of postoperative purulent complications, eliminate the possibility of anastomotic failure and reduce the risk of post-gastroresection disorders (anastomositis, stenosis).

The proposed method eliminates the need for lengthy preoperative preparation aimed at reducing body weight, and eliminates the corresponding material costs for its implementation. The use of this method will save 1 million 150 thousand rubles. when performing 100 operations.


Comparative effectiveness of the proposed method compared to the prototype
Comparison parameter	Operation according to the proposed method	Operation after preparation according to the prototype (diet therapy)
Necessity and duration of preoperative preparation	Not required	Long-term (from 2 weeks to 2 months)
The need to follow a diet	Not required	Required
Average level of intra-abdominal pressure before surgery, mm Hg.	46.3±1.0	45.6±0.7
Average level of intra-abdominal	Reduction to normal	Does not change
pressure 12 months after surgery, mm Hg.	(36.0±0.6)	(46.3±0.7)
Body weight after surgery	Decrease for everyone, without exception, by an average of 31%	In 60% it did not change. In 40% it decreased slightly (from 3 to 10%)
Hernia recurrence rate (%)	3,1	31,2
Material costs for the treatment of 1 patient, taking into account preoperative preparation and relapse rate (thousand rubles)	31,0	42,5

A method for reducing intra-abdominal pressure in case of obesity in abdominal surgery, characterized in that simultaneously with the main operation, a resection of 2/3 of the stomach, cholecystectomy, appendectomy is performed, an anastomosis of the ileum with the stomach is carried out using compression implants and at a distance of 10% of the total length of the thin intestine. intestines, from the ileocecal angle an interintestinal anastomosis is formed.

In general, the best treatment is prevention, aimed at reducing exposure to causative factors and early assessment of potential complications.

The second side of treatment tactics- elimination of any reversible cause of PPVD, such as intra-abdominal bleeding. Massive retroperitoneal bleeding is often associated with a pelvic fracture, and medical measures - pelvic fixation or vascular embolization - should be aimed at eliminating the bleeding. In some cases, patients in intensive care experience severe distension of the intestine with gases or acute pseudo-obstruction. This could be a reaction to a medication, say neostigmine methyl sulfate. If the case is severe, surgical intervention is necessary. Intestinal obstruction is also a common cause of increased IAP in patients in the intensive care unit. At the same time, few methods are capable of correcting the patient’s cardiopulmonary disorders and the level of blood electrolytes unless the underlying cause of PPVD is established.

It must be remembered that often SPVBD is only a symptom of the underlying problem. In a subsequent study of 88 patients after laparotomy, Sugr et al. noticed that in patients with IAP 18 cm H2O. the incidence of purulent complications in the abdominal cavity was 3.9 higher (95% confidence interval 0.7-22.7). If a purulent process is suspected, it is important to perform a rectal examination, ultrasound and CT. Surgery is the mainstay of treatment for patients with increased IAP caused by postoperative bleeding.

Maxwell et al. reported that early recognition of secondary PPVD, which can occur without injury to the abdominal cavity, may improve outcome.

There are currently few recommendations regarding the need for surgical decompression in the presence of increased IAP. Some investigators have shown that abdominal decompression is the only treatment option and should be performed quickly enough to prevent PPVD. Such a statement is perhaps an exaggeration, and it is not supported by research data.

Indications for abdominal decompression are related to the correction of pathophysiological disorders and the achievement of optimal IAP. The pressure in the abdominal cavity is reduced and its temporary closure is performed. There are many different options for temporary closure, including: IV bags, Velcro, silicone, and zippers. Whatever technique is used, it is important to achieve effective decompression by making appropriate incisions.

The principles of surgical decompression for elevated IAP include the following:

Early detection and correction of the cause that caused the increase in IAP.

Continued intra-abdominal bleeding along with increased IAP requires urgent surgical intervention.

Decreased urine output is a late sign of renal dysfunction; gastric tonometry or bladder pressure monitoring can give the bonze early information about visceral perfusion.

Abdominal decompression requires a total laparotomy.

The dressing material should be laid using a multi-layer technique; two drains are placed on the sides to facilitate removal of fluid from the wound. If the abdominal cavity is sealed, then a Bogota bag can be used.

Unfortunately, the development of nosocomial infection is a fairly common occurrence with open abdominal injuries, and such infection is caused by multiple flora. It is advisable to close the abdominal wound as soon as possible. But this is sometimes impossible due to constant tissue swelling. As for prophylactic antibiotic therapy, there are no guidelines for it.

The measurement of IAP and its indicators themselves are increasingly important in intensive care. This procedure is quickly becoming a routine treatment for abdominal trauma. Patients with increased IAP require the following measures: careful monitoring, timely intensive care and expansion of indications for surgical decompression of the abdominal cavity

This paper provides a review of studies devoted to determining the role of intra-abdominal pressure in the mechanism of unloading of the lumbar spine. In the process of lifting weights, the muscles of the human back ensure that the natural position of the vertebral bodies is maintained. The significant weight of the loads being lifted, as well as sudden movements, can lead to excessive tension in these muscles, which entails damage to the elements of the spinal column. This especially applies to the lumbar region of the spine. Meanwhile, some theoretical and experimental studies prove that increasing pressure in the abdominal cavity reduces the likelihood of overloading the lumbar spine. This occurs due to the fact that intra-abdominal pressure creates an additional extension moment acting on the spine in the process of holding and lifting weights, and also increases the rigidity of the lumbar spinal column. However, the relationship between intra-abdominal pressure and the condition of the spine remains poorly understood and requires an interdisciplinary approach, one of the most important areas of which is biomechanical modeling.

intra-abdominal pressure

lumbar spine

intervertebral disc

biomechanical modeling

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The spine is one of the most important segments of the human body. In addition to supporting and motor functions, the spinal column plays a significant role in protecting the spinal cord. At the same time, the structural elements of the spine (vertebrae) can move relative to each other, which is achieved by the presence of an extensive anatomical and physiological apparatus consisting of joints, intervertebral discs, as well as a large number of muscle fibers and ligaments. Despite the fairly high strength of the spinal column provided by this device, the loads that a person experiences during his life can lead to negative consequences, such as back pain, osteochondrosis, intervertebral hernia, etc. . The lower part of the lumbar spine is most vulnerable in terms of back pain and diseases associated with intervertebral disc overload. Various studies show that most often these pathologies appear during sudden or periodic lifting of weights. One of the ways to protect against this kind of overload is intra-abdominal pressure.

Lumbar spine

The lumbar spine is located in the abdominal cavity and includes five vertebrae (Fig. 1). Due to the large axial load placed on the lumbar region, these vertebrae are the largest.

Between adjacent vertebrae there are intervertebral joints, intervertebral discs, ligaments and muscle fibers, which together provide mobility and stability to the elements of the lumbar region. Of greatest interest in this segment are intervertebral discs, analysis of the stress-strain state (SSS) of which is the most important task in the prevention and treatment of common pathological conditions of the lumbar spine.

Rice. 1. Lumbar spine

At the same time, numerous studies prove the dependence of mechanical stresses arising in the lumbar intervertebral discs on the activity of the back muscles. Thus, the pressure generated by gravity in an upright torso position is not the primary factor in overloading these discs. The greatest danger in this sense is excessive contraction of the muscle that straightens the spine (m. erector spinae). During the process of lifting weights (Fig. 2), the activity of m. erector spinae helps maintain the natural alignment of the vertebrae. However, in cases where the weight of the load being lifted is large enough, holding the spine requires a strong contraction of the fibers of the erector spinae muscle, which can lead to significant compression of the intervertebral discs in the lumbar region. This, in turn, entails the appearance of back pain, as well as other negative effects.

Rice. 2. Schematic illustration of lifting weights with a straight back

Experimental determination of mechanical stresses inside human intervertebral discs is practically impossible. Therefore, most studies in this direction are based on the results of biomechanical modeling, which are evaluative in nature. To obtain accurate characteristics of the stress-strain state of the intervertebral disc, it is necessary to know the mechanical relationships in the spinal motion segment, which are currently insufficiently studied.

Biomechanical analysis of the situation depicted in Fig. 2, has been carried out in many studies (see, for example,). At the same time, different authors obtained different data. Nevertheless, they all agree that in the process of lifting weights, the load on the lumbar intervertebral discs increases several times in relation to the physiological forces acting on the lumbar spinal column in an upright position of the body.

Intra-abdominal pressure

The abdominal cavity is a space located in the body below the diaphragm and is entirely filled with internal organs. The abdominal space is limited from above by the diaphragm, from behind by the lumbar spine and the muscles of the lower back, from the front and sides by the abdominal muscles, and from below by the pelvic diaphragm.

If the volume of intra-abdominal contents does not correspond to the volume limited by the lining of the abdominal cavity, intra-abdominal pressure occurs, i.e. mutual compression of intra-abdominal masses and their pressure on the lining of the abdominal cavity.

Intra-abdominal pressure is measured at the end of expiration in a horizontal position in the absence of tension in the abdominal wall muscles using a sensor zeroed at the level of the mid-axillary line. The reference is the measurement of intra-abdominal pressure through the bladder. The normal level of intra-abdominal pressure in humans ranges from 0 to 5 mmHg on average. Art. .

The causes of increased intra-abdominal pressure can be divided into physiological and pathological. The first group of reasons includes, for example, contraction of the abdominal muscles, pregnancy, etc. A pathological increase in intra-abdominal pressure can be caused by peritonitis, intestinal obstruction, accumulation of liquids or gases in the abdominal cavity, etc.

A sustained increase in intra-abdominal pressure can cause serious pathological changes in the human body. At the same time, in the world scientific literature there are experimental data suggesting that, unlike long-term intra-abdominal hypertension, a short-term increase in intra-abdominal pressure has positive effects and can be used in the prevention of diseases of the intervertebral discs of the lumbar spine.

The influence of intra-abdominal pressure on the condition of the lumbar spine

The assumption that intra-abdominal pressure reduces compression of the lumbar vertebrae was made back in 1923. In 1957, Bartelink theoretically substantiated this hypothesis using the laws of classical mechanics. Bartelink, and subsequently Morris et al., suggested that intra-abdominal pressure is realized in the abdominal cavity in the form of a force (reaction) acting from the pelvic diaphragm. In this case, for a free (unsecured) body (Fig. 3), the laws of statics are written in the following mathematical form:

Fm + Fp + Fd = 0, (1)

rg×Fg + rm×Fm + rp×Fp = 0, (2)

where Fg is the force of gravity acting on the body; Fm - force on the part of m. erector spinae; Fd - load on the lumbosacral intervertebral disc; Fp - force from intra-abdominal pressure; rg, rm and rp are radius vectors drawn from the point of application of force Fd to the points of application of forces Fg, Fm and Fp, respectively. The sum of the moments of forces in equation (2) is determined relative to the center of the lumbosacral intervertebral disc.

Rice. 3. Diagram of a free body in a state of holding gravity. The number “1” indicates the fifth lumbar vertebra.

From Fig. 3, as well as formula (2), it is clear that in order to maintain balance under the action of a bending moment from the force of gravity (relative to the center of the lumbosacral intervertebral disc), the back extensors, contracting, create an extension moment Mm (not shown in Fig. 3). Therefore, the greater the bending moment from the force Fg, the greater the force m that needs to be developed. erector spinae and the greater the load falls on the intervertebral disc. In the presence of intra-abdominal pressure, a force Fp and an additional extension moment Mp arise (not shown in Fig. 3), determined by the third term in equation (2). Thus, intra-abdominal pressure helps to reduce the amount of force Fm required to maintain the balance of the torso with the weight in the arms and, therefore, leads to a decrease in the load on the intervertebral disc in question.

The results of in vivo experiments obtained in the work confirmed the presence of an additional moment Mp. However, the value of this moment did not exceed 3% of the maximum value of Mm. This means that the role of intra-abdominal pressure as an additional trunk extensor is not significant enough. However, any reduction in the load on the lumbar spine from the erector spinae muscle may prevent potential damage to the vertebral elements.

More significant is the effect of intra-abdominal pressure on the stiffness of the lumbar spinal column. In this case, rigidity k is understood as the following ratio:

where F is the force applied to the point on the back that corresponds to the position of the lumbar vertebra under study; Δl is the corresponding movement of this point (Fig. 4). In vivo measurements have shown that the increase in stiffness k at the level of the fourth lumbar vertebra in the presence of pressure within the abdominal cavity can reach 31%. Moreover, all observations were made in the absence of activity of the muscles of the anterior, lateral and posterior parts of the abdominal cavity membrane (including the m.erector spinae), which is important, since some authors associate an increase in the rigidity of the lumbar spinal column with an increase in the rigidity of the entire membrane abdominal cavity due to tension of its muscles.

Rice. 4. Determination of the rigidity of the lumbar spine

Thus, intra-abdominal pressure helps to reduce deformations in the lumbar spine under the influence of external forces, which, in turn, reduces the likelihood of pathological phenomena that occur during weight lifting.

Biomechanical approach to studying the influence of intra-abdominal pressure on the lumbar spinal column

The mechanism of the influence of intra-abdominal pressure on the condition of the lumbar spinal column is, of course, not fully understood. This problem is complex and interdisciplinary in nature, as it requires the knowledge of specialists in various fields. One of the most important areas of an interdisciplinary approach to the study of the presented relationship is biomechanical modeling. The use of modern computer technologies and computational algorithms to determine quantitative patterns of interaction between intra-abdominal contents and elements of the lumbar spine will make it possible to develop defining relationships that take into account, among other things, individual characteristics. This explains the need to study the problem under consideration from the point of view of biomechanics.

Conclusion

Intra-abdominal pressure is a complex physiological parameter. Along with the negative impact on the organs and systems of the human body, pressure in the abdominal cavity, which is briefly increased during the process of lifting weights, can prevent injuries to the lumbar spinal column. However, the relationship between intra-abdominal pressure and the condition of the lumbar spine is poorly understood. Therefore, interdisciplinary studies aimed at establishing the quantitative dependencies of the described phenomenon are necessary from the point of view of developing preventive measures to reduce the trauma of the lumbar elements of the spine.

Reviewers:

Akulich Yu.V., Doctor of Physical and Mathematical Sciences, Professor of the Department of Theoretical Mechanics, Perm National Research Polytechnic University, Perm;

Gulyaeva I.L., Doctor of Medical Sciences, Head of the Department of Pathological Physiology, Perm State Medical Academy named after. acad. E.A. Wagner" of the Ministry of Health of the Russian Federation, Perm.

The work was received by the editor on June 18, 2013.

Bibliographic link

Tuktamyshev V.S., Solomatina N.V. INFLUENCE OF INTRA-ABDOMINAL PRESSURE ON THE CONDITION OF THE LUMBAR SPINE // Fundamental Research. – 2013. – No. 8-1. – P. 77-81;
URL: http://fundamental-research.ru/ru/article/view?id=31874 (access date: 03/18/2019). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"

Normally, a special constant environment is maintained inside our body, different from the outside world. And if its balance is disturbed, a person faces a number of unpleasant symptoms. This condition requires close attention and proper, adequate correction under the supervision of a qualified doctor. Probably every person has already heard about the likelihood of increased arterial, intraocular and intracranial pressure. Also, in recent years, doctors have been actively using the terms “intra-abdominal pressure” and “increased intra-abdominal pressure”, the symptoms and causes of which, as disorders, as well as its treatment, we will now consider.

Why does intra-abdominal pressure increase, what are the reasons for this?

Increased intra-abdominal pressure is often a consequence of the accumulation of gases inside the intestines. Persistent accumulation of gases can develop due to many congestive phenomena, for example, against the background of various hereditary and severe surgical pathologies. In addition, such trouble can arise as a result of more banal conditions, including constipation, irritable bowel syndrome and consumption of foods that provoke increased gas formation.

An increase in intra-abdominal pressure in most cases is observed in a condition such as irritable bowel syndrome with a noticeable predominance of reduced tone in the autonomic region of the nervous system. In addition, this pathological condition develops with inflammatory bowel lesions, represented by Crohn's disease, various colitis and even hemorrhoids.

Among the reasons for increased intra-abdominal pressure, it is also worth noting some surgical pathologies, for example, intestinal obstruction. This problem can be caused by closed abdominal injuries, peritonitis, pancreatic necrosis, a variety of abdominal diseases and surgical interventions.

How does intra-abdominal pressure manifest, what symptoms indicate it?

In itself, an increase in intra-abdominal pressure usually has virtually no effect. The patient has bloating. In addition, he may be bothered by painful sensations in the peritoneal area, which are bursting in nature. The pain can suddenly change location.
If there is a suspicion of increased intra-abdominal pressure, doctors are required to constantly monitor this indicator. If a patient has several risk factors, specialists must be constantly prepared to carry out therapeutic measures.

How is intra-abdominal pressure corrected, what treatment helps?

Treatment of intra-abdominal hypertension depends on the causes of its occurrence, as well as the degree of development of the disease. In the case of surgical patients who are likely to develop abdominal compression syndrome (the so-called multiple organ failure caused by increased intra-abdominal pressure), they need to carry out therapeutic measures at the very first manifestations of disorders, without waiting for the development of problems with internal organs.

In patients with increased intra-abdominal pressure, installation of a nasogastric or rectal tube is indicated. In certain cases, both types of probes are installed. Such patients are prescribed gastro and coloprokinetic medications, enteral nutrition is minimized, and sometimes it is stopped altogether. Ultrasound and CT are used to detect pathological changes.

In case of intraperitoneal hypertension, it is customary to take measures to reduce the tension of the abdominal wall; for this purpose, appropriate sedatives and analgesics are used. For this purpose, doctors must remove tight clothing, including bandages, and do not raise the head of the bed above twenty degrees. In certain cases, muscle relaxants are administered to reduce tension.

When conservatively correcting elevated intra-abdominal pressure, it is extremely important to avoid excessive infusion load and remove fluid by adequately stimulating diuresis.

If intra-abdominal pressure rises above 25 mm Hg, and the patient experiences organ dysfunction or even failure, a decision is often made to perform surgical abdominal decompression.

Timely implementation of surgical intervention for decompression allows, in most cases, to normalize the impaired functioning of organs - stabilize hemodynamics, reduce the manifestations of respiratory failure and normalize diuresis.
However, surgical treatment can provoke a number of complications, including hypotension and thromboembolic complications. In certain cases, surgical decompression leads to the development of reperfusion and causes a significant amount of under-oxidized substrates, as well as intermediate products of metabolic processes, to enter the bloodstream. This can cause cardiac arrest.

If intra-abdominal pressure causes the development of abdominal compression syndrome, the patient may need artificial ventilation, and infusion therapy is also carried out mainly with crystalloid solutions.

It is worth remembering that in the absence of adequate correction, intra-abdominal hypertension often causes the development of abdominal compression syndrome, which in turn can provoke multiple organ failure with a fatal outcome.

Ekaterina, www.site

P.S. The text uses some forms characteristic of oral speech.

Many people do not attach much importance to such manifestations as pain in the abdominal area, regular bloating, or discomfort when taking the next portion of their favorite treat. In fact, such phenomena can be dangerous and mean the development of various pathologies. It is almost impossible to detect intra-abdominal pressure without examination, but sometimes, based on some characteristic symptoms, you can still recognize the disease and consult a doctor in a timely manner.

The abdominal cavity is, in fact, a closed space filled with fluid, as well as organs that press on the bottom and walls of the abdominal part. This is what is called intra-abdominal pressure, which can change depending on body position and other factors. With excessively high pressure, there is a risk of pathologies occurring in various human organs.

Norm and levels of increase

To understand which indicator is considered elevated, you need to know the norms of a person’s intra-abdominal pressure. They can be found in the table:

An increase in indicators by more than 40 units most often leads to serious consequences - deep venous thrombosis, the movement of bacteria from the intestines into the circulatory system, etc. When the first symptoms of intra-abdominal pressure appear, you should consult a doctor as soon as possible. Since even with an increase of 20 points (intra-abdominal syndrome), quite serious complications can arise.

Note. It is not possible to determine the level of IAP by visual examination of the patient or by palpation (palpation). To find out the exact values of intra-abdominal pressure in a person, it is necessary to carry out special diagnostic procedures.

Reasons for the increase

One of the most common causes of IAP disorders is considered to be increased gas formation in the intestines.

In addition, increased pressure in the abdominal cavity can be affected by:

Obesity of any severity;
Intestinal problems, in particular constipation;
Foods that promote gas formation;
Irritable bowel syndrome;
Hemorrhoidal disease;
Gastrointestinal pathologies.

Increased intra-abdominal pressure can occur due to peritonitis, various closed injuries of the abdominal part, as well as due to a lack of any micro and macroelements in the patient’s body.

Exercises that increase intra-abdominal pressure

In addition to the fact that high intra-abdominal pressure can be a consequence of pathological changes, it can also increase due to certain physical exercises. For example, push-ups, lifting a barbell of more than 10 kg, bending forward and others that affect the abdominal muscles.

This deviation is temporary and, as a rule, does not pose a danger to human health. We are talking about a one-time increase associated with external factors.

In case of regular violation after each physical activity, you should abandon exercises that increase intra-abdominal pressure and switch to more gentle gymnastics. If this is not done, the disease may become permanent and become chronic.

Symptoms of increased intra-abdominal pressure

A minor violation cannot always be recognized immediately. However, with high pressure with readings of 20 mm Hg. In almost all cases, characteristic symptoms arise. Such as:

Strong feeling in the stomach after eating;
Pain in the kidney area;
Bloating and nausea;
Problems with bowel movements;
Pain in the peritoneal area.

Such manifestations may indicate not only increased intra-abdominal pressure, but also the development of other diseases. That is why it is very difficult to recognize this pathology. In any case, whatever the reasons, self-medication is strictly prohibited.

Note. Some patients may experience an increase in blood pressure, which may result in symptoms characteristic of hypertension, such as headaches, dizziness, general weakness, and others.

Measurement methods

It is not possible to measure the level of intra-abdominal pressure on your own. These procedures can only be performed by a qualified specialist in a hospital setting. There are currently three measurement methods:

Through the bladder using a special catheter;
Water-perfusion technique;
Laparoscopy.

The first option for measuring intra-abdominal pressure is the most common, but it cannot be used for any injuries of the bladder, as well as tumors of the pelvis and retroperitoneum. The second method is the most accurate and is carried out using special equipment and a pressure sensor. The third method gives the most accurate results, but the procedure itself is quite expensive and complicated.

Treatment

Therapy methods are selected individually, depending on the complexity of the disease. First, the main cause that influenced the change in IAP is eliminated, and only then are medications prescribed to normalize blood pressure and eliminate various symptoms. For these purposes the following are most often used:

Antispasmodics;
Muscle relaxants (to relax muscles);
Sedatives (reducing tension in the abdominal wall);
Medicines to reduce intra-abdominal pressure;
Medicines to improve metabolism and others.

In addition to drug therapy, experts recommend taking certain precautions. With high IAP you cannot:

Wear tight clothes;
Be in a lying position higher than 20-30 degrees;
Overload with physical exercise (with the exception of light gymnastics);
Eating foods that cause increased gas formation;
Abuse alcohol (it increases blood pressure).

The disease is quite dangerous, so any improper self-medication can lead to aggravating consequences. To ensure the most favorable outcome, when the first signals are detected, you should immediately consult a doctor. This will help to quickly identify pathology and begin a timely course of therapeutic measures.