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Kardioprotektion in der perioperativen Phase bei nichtkardialen Eingriffen

  • M. Zaugg
Chapter
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Zusammenfassung

Weltweit müssen sich Millionen von Patienten mit koronarer Herzkrankheit (KHK) oder Verdacht auf eine KHK einem nichtkardialen operativen Eingriff unterziehen. Etwa 5–15% dieser Patienten erleiden schwerwiegende kardiovaskuläre Komplikationen, die jährlich zusätzliche Gesundheitskosten in Milliardenhöhe verursachen. Eine optimale perioperative Kardioprotektion ist deshalb aus menschlicher und gesundheitspolitischer Sicht von enormer Tragweite.

Die präoperative Evaluation jedes einzelnen Patienten stellt einen wichtigen Eckpfeiler in der perioperativen Kardioprotektion dar. Sie erlaubt, Hochrisikopatienten zu erkennen und notwendige therapeutische Interventionen wie eine prophylaktische medikamentöse Kardioprotektion mit β-Blockern oder α2-Agonisten, eine Koronarangioplastie oder gar eine koronare Revaskularisation einzuleiten. Nach den Richtlinien des American College of Physicians sollte jeder Patient mit KHK oder Risikofaktoren für eine KHK — vorausgesetzt er hat kein Asthma oder relevante bradykarde Herzrhythmusstörungen — perioperativ β-blockiert werden. Diese Empfehlung basiert auf den Resultaten neuer Studien, die eine 10-fach verminderte kardiovaskuläre Komplikationsrate und ein deutlich verbessertes Langzeitüberleben nach perioperativer β-Blockade bei kardialen Risikopatienten aufzeigen konnten. Der kardioprotektive Effekt von β-Blockern und α2-Agonisten liegt im Wesentlichen in der Verhinderung stressinduzierter Tachykardien, welche insbesondere postoperativ Myokardischämien provozieren. Schließlich zählen zu den perioperativen kardioprotektiven Maßnahmen auch eine optimale Schmerztherapie, das Vermeiden von hämodynamischen Abnormitäten, eine aggressive Therapie der Hypothermie, eine optimale Volumen- und Elektrolytsubstitution, eine Hemmung der Hyperkoagulabilität und das Sistieren des perioperativen Nikotinabusus.

Die folgenden Ausführungen beziehen sich im Wesentlichen auf das perioperative Management von Patienten, die sich einem elektiven nichtkardialen operativen Eingriff unterziehen müssen.

Keywords

Cardioprotection Noncardiac surgery Cardiovascular morbidity and mortality Myocardial ischemia Tachycardia β-Adrenergic antagonists α2-Agonists Tutorial 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • M. Zaugg
    • 1
  1. 1.Institut für AnästhesiologieUniversitätsSpital ZürichZürichSwitzerland

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