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Neue Therapieansätze bei der prähospitalen und hospitalen Schockbehandlung

Hyperton-hyperonkotische Lösungen und Vasopressin

  • Schwerpunkt: Der Patient mit Schock
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Zusammenfassung

Die hochgradige Störung der Hämodynamik im Schock führt zu einer Verringerung des Sauerstoffangebots lebenswichtiger Organe. Wird dieser Zustand nicht rasch behoben, kann es zu einem Multiorganversagen kommen. Neben der Beseitigung der Schockursache, wie z. B. einer Blutung oder eines septischen Fokus, müssen Maßnahmen eingeleitet werden, die zu einer Stabilisierung der Hämodynamik führen. In vielen Fällen gelingt dies durch Flüssigkeitsersatz oder durch Einsatz von Inotropika und Vasopressoren. Beim hypovolämischen Schock konnten hyperton/hyperonkotische Lösungen bisher keine Vorteile gegenüber herkömmlichen Infusionen zeigen, außer in Situationen, in denen nicht sofort genügend Ressourcen für eine primäre Versorgung zur Verfügung stehen. Im Tierexperiment konnte die Hämodynamik mit Vasopressin deutlich besser als mit Volumen stabilisiert werden, wenn eine unstillbare intraabdominelle Blutung vorlag. Auch die Letalität war bei den mit Vasopressin behandelten Tieren signifikant niedriger. Es fehlen aber noch klinische Arbeiten, die diese Ergebnisse bestätigen. Vasopressin trägt im septischen Schock sowohl in niedriger als auch in hoher Dosierung zu einer Stabilisierung der Hämodynamik bei. Allerdings kommt es dabei zu einer Beeinträchtigung der Splanchnikusperfusion. Deshalb kann der Einsatz von Vasopressin im septischen Schock zurzeit nicht empfohlen werden.

Abstract

The extreme disturbance of hemodynamics in shock leads to a minimized oxygen delivery to several vital organs. If this state is not rapidly lifted, a multi-organ-failure can occur. In addition to the removal of the underlying causes, for example, bleeding or septic focus, measures must be started to stabilize hemodynamics. In most cases shock can be successfully treated with standard therapeutic interventions including the use of crystalloid or colloid solutions as well as the infusion of inotropes or vasopressors. Up to now, there is not enough evidence to show that hypertonic/hyperoncotic solutions are better for treating hypovolemic shock than standard infusions, other than in situations, where only an inadequate equipment is available. Experimental data support the use of vasopressin instead of fluid loading in case of uncontrolled intra-abdominal bleeding. According to these studies vasopressin seems to be associated with an improved hemodynamic stabilization and a significantly lower mortality rate. However, no clinical tests have been done so far to confirm these results. In septic shock the plasma-levels of vasopressin are low. It has been shown that the infusion of vasopressin contributes to stabilization of hemodynamics in septic shock, in lower, as well as in higher concentrations. On the other hand vasopressin worsens splanchnic perfusion. Therefore the routine use of vasopressin in the treatment of sepsis can not be recommended.

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  1. Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, HELIOS-Klinikum Erfurt GmbH

    A. Meier-Hellman &  G. Burgard

  2. Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, HELIOS-Klinikum Erfurt GmbH, Nordhäuser Straße 74, 99089, Erfurt

    G. Burgard

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Meier-Hellman, A., Burgard, G. Neue Therapieansätze bei der prähospitalen und hospitalen Schockbehandlung. Internist 45, 305–314 (2004). https://doi.org/10.1007/s00108-003-1141-z

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