A Clinical Study Of Correlation Between Change Of Intra-abdominal Pressure And The Severity Of Acute Pancreatitis

Purpose: To investigate the correlation between the severity of acute pancreatitis and intra-abdominal pressure. Methods: The stduy was divided into two parts: Part ITo investigate the correlation between intra-vesicle pressure and intra-abdominal pressure: Thirty patients undergone elective laparoscopic cholecystectomy in department of Hepato-Biliary Surgery, People's Hospital of Shenzhen between October 2002 and January 2003 were selected. The bladder was emptied and filled with 50 ml sterile saline through a Foley catheter. An 18G pneumoperitoneal puncture needle was inserted and connected to an auto-manometer with electric air pump. When the intra-abdominal pressure reached 0, 5, 10, 15, 20, 25 mmHg, the corresponding intravesical pressure were recorded respectively. Part IITo monitor the intra-abdominal pressure of patients with acute pancreatitis using indirect method: Thirty-eight patients with acute pancreatitis admitted in the people's hospital of Shenzhen between May 2002 and April 2003 were recruited. All patients were admitted within 48 hours from the disease onset. The intra-abdominal pressure of all the patients was measured q8h by indirect method after admission. The procedure would be terminated when either there were manifestations of disease subside (e.g. passing flatus) or disease progress that surgical intervention was needed. The Hanson's criteria and APACHE II score were also recorded. Results:1 When the urinary bladder was filled with 50 ml sterile saline and the intra-abdominal pressure was raised from 0 to 25 mmHg, a linear correlation was observed between intravesical pressure and intra-abdominal pressure (r=0.939, P<0.01, r2 =0.882).2 Significant correlation was demonstrated between Intra-abdominal pressure and APACHE II score (r=0.874, P<0.01, r2 =0.763). Intra-abdominal pressure also correlated with Ranson's criteria (r=0.735, P<0.05, r2=0.568).Conclusion:1. The intra-abdiminal pressure can be accurately estimated by measurement of intra-vesical pressure.2. Change of the intra-abdominal pressure correlates with the severity of acute pancreatitis.3 Routine monitoring of the abdominal pressure to patients with severe acute pancreatitis is on one hand, essential in the diagnosis of abdominal compartment syndrome (ACS), on theother hand, can help to determine the suitable time for surgical intervention in patients with severe pancreatitis.