Der Chirurg

, Volume 78, Issue 2, pp 101–109 | Cite as

Vorgehen bei kritischer nichtchirurgischer Großblutung

Leitthema
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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.

Schlüsselwörter

Hämostasis Koagulopathie Embolisation Damage control 

Procedure for critical nonsurgical bleeding

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.

Keywords

Hemostasis Coagulopathy Embolization Damage control 

Notes

Interessenkonflikt

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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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Klinik für AnästhesiologieUniversitätsklinikum AachenAachenDeutschland

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