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Stressläsionen im oberen Gastrointestinaltrakt

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Weiterbildung Anästhesiologie

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Zusammenfassung

Klinisch relevante Blutungen aus Stressläsionen des oberen Gastrointestinaltrakts von Intensivpatienten sind sehr selten, die Letalität beträgt jedoch bis zu 13% (van Leerdam, Best Pract Res Clin Gastroenterol 2008; 22:209–224), Betroffen sind Patienten mit Perfusionsstörungen der Mikrozirkulation. Hierbei versagen Schutzmechanismen, deren Funktionalität an einen ausreichenden nutritiven Blutfluss gebunden ist. Das acide Magenmilieu verhindert eine ausreichende Hämostase kleinster Blutungen und damit auch die Abheilung von Mikrotraumen, z, B. durch Eraährangssonden. Maschinelle Beatmung und das Vorliegen einer Cerinnungsstörung bzw. therapeutische Antikoagulation (bei Vorhofflimmern, Nierenersatzverfahren, herzunterstützenden Systemen) erhöhen das Blutungsrisiko deutlich. In diesen Fällen sollte eine medikamentöse Prophylaxe durchgeführt werden. Diesbezüglich sind H2-Rezeptoran-tagonisten (H2RA) und Protonenpumpen Inhibitoren (PPI) gleichwertige Substanzen, aufgrund des geringeren Nebenwirkungsprofils sollten aber H2RA favorisiert werden. Die Gabe von PPI ist bei stattgehabter bzw. aktiver Blutung indiziert und verhindert eine Eskalation der Blutung. Die medikamentöse Therapie sollte schon vor der Endoskopie beginnen. Eine Endoskopie ist hei klinisch relevanter Blutung indiziert, da damit diagnostisch und therapeutisch interveniert werden kann.

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  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Augsburg

    U. Jaschinski

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  1. U. Jaschinski
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Jaschinski, U. (2013). Stressläsionen im oberen Gastrointestinaltrakt. In: Weiterbildung Anästhesiologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40715-4_8

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  • DOI: https://doi.org/10.1007/978-3-642-40715-4_8

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-40714-7

  • Online ISBN: 978-3-642-40715-4

  • eBook Packages: Medicine (German Language)

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