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Vorgehen bei kritischer nichtchirurgischer Großblutung

Procedure for critical nonsurgical bleeding

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Zusammenfassung

Die Verbesserung chirurgischer Techniken und konventioneller Therapien zur Kontrolle von Massenblutungen eröffnet neue Strategien in der Behandlung traumatisierter Patienten. Die Massenblutung wird zum einen auf die Gewebsverletzung zurückgeführt und begründet sich zum anderen auf das Vorliegen einer multifaktoriell bedingten Gerinnungsstörung, die u.a. durch den blutungsbedingten Verlust bzw. Dilution der Gerinnungsfaktoren und Thrombozyten verursacht wird. Zur Behandlung einer manifesten Koagulopathie wird daher zumeist eine empirische Therapie mit hämostatisch wirksamen Blutprodukten eingeleitet.

Die Transfusion von Erythrozytenkonzentraten ist allerdings komplikationsbehaftet, da sie mit postoperativen Infektionen und Multiorganversagen assoziiert ist. Im Behandlungsalgorithmus der Massenblutung ist daher eine klare Strategie zur Verhinderung einer Koagulopathie bzw. zur Wiederherstellung des hämostatischen Gleichgewichtes erforderlich. Dadurch kann ein Ausbluten des Patienten unter Umständen verhindert werden und die Notwendigkeit zur Transfusion mit Erythrozyten minimiert werden.

Abstract

The improvement of surgical and nonsurgical approaches to control bleeding offers new strategies for overcoming coagulopathy. Massive hemorrhage is usually caused by a combination of surgical and coagulopathic bleeding. Coagulopathy is multifactorial and results from the dilution and consumption of both platelets and coagulation factors and dysfunction of the coagulation system. Blood component therapy continues to be a mainstay for this coagulopathy-related bleeding. However, the transfusion of red blood cells has been shown to be associated with post-injury infection and multiple organ failure. Therefore it is crucial to develop a clear strategy for correcting coagulopathy, preventing exsanguination, and minimizing the need for blood transfusion.

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Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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  1. Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    O. Grottke & R. Rossaint

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  1. O. Grottke
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  2. R. Rossaint
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Correspondence to O. Grottke.

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Grottke, O., Rossaint, R. Vorgehen bei kritischer nichtchirurgischer Großblutung. Chirurg 78, 101–109 (2007). https://doi.org/10.1007/s00104-006-1285-1

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