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Septischer Kreislaufschock und septische Kardiomyopathie

Septic shock and septic cardiomyopathy

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Zusammenfassung

Beim septischen Schock wird unser Verständnis der hämodynamischen Veränderungen überwiegend von der Störung der Tonusregulation der arteriellen Blutgefäße (Vasodilatation und Vasoplegie) dominiert. Bei vielen Patienten findet sich jedoch auch eine sepsisbedingte Störung der Herzfunktion. Erhöhte Troponinblutspiegel weisen auf die septische Kardiomyopathie hin, wobei die Troponinerhöhungen meist nicht als Ausdruck einer koronaren Minderperfusion anzusehen sind. Neben der Einschränkung der systolischen Pumpleistung ist die septische Kardiomyopathie durch eine Störung von Herzfrequenzregulation und -variabilität (HRV) charakterisiert. Für die Erfassung des Schweregrads der septischen Kardiomyopathie sollte das Herzzeitvolumen im Verhältnis zur jeweiligen Nachlast (SVR) betrachtet werden, z. B. durch den Parameter nachlastbezogene Herzleistung („afterload-related cardiac performance“, ACP). Die Therapie des septischen Schocks und der septischen Kardiomyopathie basiert auf den bekannten kausalen, supportiven und adjunktiven Ansätzen. Für die Stabilisierung der Herzfunktion stehen die adäquate Volumengabe (ggf. mit Erythrozytenkonzentraten) sowie die Gabe von Dobutamin im Vordergrund; spezifische Therapieansätze konnten bislang nicht etabliert werden.

Abstract

Patients suffering from septic shock often present with not only severe reduction of afterload induced by vasodilation but are also affected by sepsis-induced cardiac dysfunction. Elevated troponin levels, which are typically not caused by coronary ischemia, may indicate septic cardiomyopathy which is characterized both by altered systolic function as well as by disturbances in the regulation of heart rate and heart rate variability. The latter findings are based not only on the dysfunction of the autonomous nervous system but are also the result of the direct interaction of endotoxins with cardiac pacemaker cells. In order to quantify the extent of septic cardiomyopathy, cardiac output has to be considered in the light of the existing afterload, i.e., by the parameter ‘afterload-related cardiac performance’ (ACP). Therapy of septic shock (and thereby septic cardiomyopathy) is based on the well-known causative, supportive, and adjunctive strategies. Stabilization of cardiac function is assured by volume resuscitation (including blood transfusion) and inotropic support (dobutamine). Further specific therapeutic approaches have not yet been established.

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  1. Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale) , Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle, Deutschland

    H. Ebelt & K. Werdan

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  1. H. Ebelt
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  2. K. Werdan
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Correspondence to H. Ebelt.

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Ebelt, H., Werdan, K. Septischer Kreislaufschock und septische Kardiomyopathie. Med Klin Intensivmed Notfmed 107, 24–28 (2012). https://doi.org/10.1007/s00063-011-0031-8

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  • DOI: https://doi.org/10.1007/s00063-011-0031-8

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