Krenov K. Diagnosis, prevention and intensive therapy of organ lesions in patients with intra-abdominal hypertension and abdominal compartment syndrome in acute surgical pathology of the abdominal cavity

It was found that IAHS developed in 64.15% of patients, whereas ACS in 14.2% of cases. It has been experimentally proven that combined nerve blocks effectively reduce IAP within six hours after their performing, thoughit is a short-term effect. Likewise, in the group with experimentally-induced peritonitis after performing nerve blocks using lidocaine solution, morphological changes in the kidneys and peritoneum were less pronounced. The clinical part of the dissertation was based on the analysis of the course of acute surgical pathology of the abdominal cavity in 120 patients, who were divided into four groups. The control group consisted of patients using opioid analgesia, for the second group the intravenous lidocaine infusion was added to the standard anesthesia, the third group received epidural analgesia, and the fourth group received combined nerve blocks. The frequency of IAH in patients of the control group made 63.3%, among which ACS developed in 10% of cases, in the group of patients using continuous lidocaine infusion - in 63.3% and 13.3%, respectively, figures for epidural analgesia are 53.3% and 10 %, respectively, and in the group where the combined nerve block were used in 76.7% of cases, although ACS developed only in 3.3% of patients. When analyzing the effect and studying the effectiveness of conservative methods for IAH correction, it was found that the IAP levels significantly differ for different methods of analgesia in lethal cases and in patients who survived (p = 0.04741). The highest dynamics of the IAP decrease was observed in the survivors as opposed to the deceased in the group using opioid analgesia compared with the group using lidocaine and nerve blocks (p = 0.015883 and p = 0.027963). Cystatin-C levels differed significantly in all groups between surviving and deceased patients, and cystatin-C is a reliable early marker of renal dysfunction / insufficiency as a component of multiorgan failure syndrome.