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Blutung, Schock und Sepsis

Hemorrhage, shock, and sepsis

  • Operative Gynäkologie, Gynäkologische Onkologie
  • Blutung, Schock, Sepsis
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

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Summary

hemorrhage and sepsis may lead to multiple organ system failure caused by a redistribution of cardiac output and a reduction of tissue perfusion. The pathophysiologic changes caused by hemorrhage are frequently prevented by rapid diagnosis of the cause of the bleeding (e.g., vessel injury or coagulation disorder) and its therapy. The pathophysiologic changes in sepsis are mediated by toxins which affect almost every organ system. Knowledge of the predisposing factors, rapid recognition of signs and symptoms, and understanding of the underlying pathobiochemical and pathophysiologic changes are mandatory in the successful therapy of septic shock. The main therapeutic principle remains removal of the focus.

Zusammenfassung

Blutung und Sepsis können durch Fehlverteilung des Herz-zeitvolumens mit Reduktion der Gewebeperfusion zu einem Multiorganversagen führen. Die pathophysiologischen Veränderungen der Blutung können dabei durch rechtzeitiges Erkennen der Blutungsursache (Blutung infolge Gefäßverletzung, Gerinnungsstörung) und deren Beseitigung meist behoben werden. Die pathophysiologischen Veränderungen der Sepsis werden durch Toxine hervorgerufen, deren mediatorvermittelte, kaskadenartige Wirkung nahezu alle Organsysteme des Körpers beeinflußt. Das Wissen um prädisponierende Faktoren für die Entwicklung dieses Krankheitsbildes, rechtzeitiges Erkennen der Zeichen und Symptome, Verständnis der pathobiochemischen und pathophysiologischen Veränderungen sind unabdingbar für eine erfolgreiche Therapie des septischen Schocks, deren Schwerpunkt die Herdsanierung ist.

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Literatur

  1. Aronson MD, Bor DH (1987) Guidelines for the use of blood cultures to diagnose bacteremia. Intens Crit Care Digest 6:45–46

    Google Scholar 

  2. Ball HA, Cook JA, Wise WC, Halushka PV (1986) Role of thromboxane, prostaglandins and leukotrienes in endotoxic and septic shock. Intensive Care Med 12:116–126

    Article  CAS  PubMed  Google Scholar 

  3. Bernard GR, Luce JM, Sprung CL, Rinaldo JE, Tate RM, Sibbald WJ, Kariman K, Higgins S, Bradley R, Metz CA, Harris TR, Brigham KL (1987) High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med 317:1565–1570

    Article  CAS  PubMed  Google Scholar 

  4. Beutler B, Milsark IW, Cerami AC (1985) Passive immunization against cachectin/tumor necrosis factor protects mice from lethal effect of endotoxin. Science 229:869–871

    CAS  PubMed  Google Scholar 

  5. Beutler B, Cerami A (1987) Cachectin: More than a tumor necrosis factor. N Engl J Med 316:379–385

    Article  CAS  PubMed  Google Scholar 

  6. Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA (1987) A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 317:653–658

    Article  CAS  PubMed  Google Scholar 

  7. Francis CW, Alkjaersig N, Galanakis DK, Graeff H, Owen J, Gaffney P, Marder VJ (1987) Terminology for macromolecular plasmic derivatives of crosslinked fibrin. Thrombos Haemos 57:110–111

    CAS  Google Scholar 

  8. Giradin E, Grau GE, Dayer JM, Roux-Lombard P, J5 Study Group, Lambert PH (1988) Tumor necrosis factor and interleukin-1 in the serum of children with severe infections purpura. N Engl J Med 319:397–400

    Article  Google Scholar 

  9. Graeff H, Hafter R, Bachmann L (1979) Subunit and macromolecular structure of circulating fibrin from obstetric patients with intravascular coagulation. Thrombos Res 16:313–328

    Article  CAS  Google Scholar 

  10. Graeff H, Kuhn W (1980) Coagulation Disorders in Obstetrics. Thieme, Stuttgart New York

    Google Scholar 

  11. Graeff H, Hafter R (1982) Detection and relevance of crosslinked fibrin derivatives in blood. Seminars Thrombos Hemost 8:57–68

    CAS  Google Scholar 

  12. Graeff H (1984) Der bakterielle Schock. Gyn=:akologe 17:88–95

    CAS  Google Scholar 

  13. Hayashi R (1987) Obstetric hemorrhage and hypovolemic shock. In: Clark SL, Phelan JP, Cotton DB (eds) Critical Care Obstetrics. Medical Economics Books, Oradell NJ, pp 170–183

    Google Scholar 

  14. Högberg U (1986) Maternal deaths in Sweden (1971–1980) Acta Obstet Gynecol Scand 65:161–167

    Article  PubMed  Google Scholar 

  15. von Hugo R, Rust M, Deckardt R, Graeff H (1984) Fruchtwasserembolie. Gynäkologe 17:124–130

    Google Scholar 

  16. von Hugo R, Graeff H (1987) Thrombohemorrhagic complications in the obstetric patients. In: Colman RW, Hirsh J, Marder VJ, Salzman EW (eds) Hemostasis and Thrombosis: Basic Principles and Clinical Practice, 2nd ed., Lippincott, Philadelphia, pp 926–941

    Google Scholar 

  17. Hund F, Müller F, Wagner J, Lode H (1988) Erregerwandel bei Sepsis. Arzneimitteltherapie 2:33–34

    Google Scholar 

  18. Jochum M, Witte J, Duswald KH, Inthorn D, Welter H, Fritz H (1986) Pathobiochemie und Chirurgie: Neue Ansätze zur Diagnostik und Therapie schwerer entzündlicher Erkrankungen. In: Eigler FW, Peiper HJ, Schildberg FW, Witte J, Zumtobel V (Hrsg) Stand und Gegenstand chirurgischer Forschung. Springer, Berlin Heidelberg, S 73–84

    Google Scholar 

  19. Kruse JA (1987) Blood lactate and oxygen transport. Intensive Care World 4: 121–125

    Google Scholar 

  20. Kuhn W (1989) HELLP-Syndrom. Arch Gyn (im Druck)

  21. Kujath P, Arbogast R, Kern E, Dämmrich J (1985) Histologische Untersuchungen während des Verlaufs der programmierten Peritoneal-Lavage. Chirurg 56:170–172

    CAS  PubMed  Google Scholar 

  22. Lachman E, Pitsoe SB, Gaffin SL (1984) Anti-lipopolysaccharide immunotherapy in management of septic shock of obstetric and gynaecological origin. Lancet 1:981–983

    Article  CAS  PubMed  Google Scholar 

  23. Lohe KJ, Lampe B, Graeff H, Holzmann K, Zander J (1983) Die Hysterektomie bei Sepsis nach Kaiserschnitt. Geburtsh Frauenheilk 43:27–32

    Article  CAS  PubMed  Google Scholar 

  24. Loos W, von Hugo R, Rath W, Muck BR, Albrecht M, Graeff H, Kuhn W, Zander J (1988) Die puerperale Ovarialvenenthrombophlebitis (POVT) — eine seltene Wochenbettskomplikation. Geburtsh Frauenheilk 48:483–488

    CAS  PubMed  Google Scholar 

  25. Ludwig H, Genz HJ (1988) Blutgerinnung und Schock, Gerinnungsstörungen. In: Käser O, Friedberg V, Ober KG, Thomsen K, Zander J (Hrsg) Gynäkologie und Geburtshilfe III/2 2. Aufl., Thieme, Stuttgart, S 20.1–20.28

    Google Scholar 

  26. McCue JD (1985) Improved mortality in gram-negative bacillary bacteremia. Arch Intern Med 145:1212–1216

    Article  CAS  PubMed  Google Scholar 

  27. Messmer K, Kreimeier U, Hammersen F (1988) Multiple organ failure: Clinical implications to macro- and microcirculation. In: Manabe H, Zweifach BW, Messmer K (eds) Microcirculation in circulatory disorders. Springer, Tokyo Berlin Heidelberg New York London Paris, pp 147–157

    Google Scholar 

  28. Michie HR, Manogue KR, Spriggs DR, Revhaug A, O'Dwyer S, Dinarello CA, Cerami A, Wolff SM, Silmore DW (1988) Detection of circulating tumor necrosis factor after endotoxin administration. N Engl J Med 318:1481–1486

    Article  CAS  PubMed  Google Scholar 

  29. Müller-Berghaus G (1987) Septicemia and the vessel wall. In: Verstraete M, Vermylen J, Lijnen HR, Arnout J (eds) Thrombosis and Haemostasis. Int. Soc. Thrombosis and Haemostasis, Leuven University Press, Leuven pp 619–671

    Google Scholar 

  30. Neugebauer E, Lorenz W, Maroske D, Barthlen W (1987) Mediatoren beim septischen Schock: Strategien zu ihrer Sicherung und zur Einschätzung ihrer kausalen Bedeutung. Chirurg 58:470–481

    CAS  PubMed  Google Scholar 

  31. Olofsson P, Olofsson C, Nylander G, Olsson P (1986) Endotoxin inactivation in plasma from septic patients: an in vitro study. World J Surg 10:318–323

    Article  CAS  PubMed  Google Scholar 

  32. Olofsson P, Nylander G, Olsson P (1986) Endotoxin: routes of transport in experimental peritonitis. Am J Surg 151:443–447

    Article  CAS  PubMed  Google Scholar 

  33. Rosenberg MJ, Rosenthal SM (1987) Reproductive mortality in the United States: recent trends and methodologic considerations. Am J Public Health 77/833:229–230

    Google Scholar 

  34. Rylatt DB, Blake AS, Cottis LE, Massingham DA, Fletcher WA, Masci PP, Whitaker AN, Elms N, Bunce I, Webber AJ, Wyatt D, Bundesen PG (1983) An immunoassay for human d-dimer using monoclonal antibodies. Thrombos Res 31:767–778

    Article  CAS  Google Scholar 

  35. Schedel I (1988) New aspects in the treatment of gram-negative bacteraemia and septic shock. Infection 16:8–11

    Article  Google Scholar 

  36. Sies H (1986) Biochemie des oxidativen Stress. Angew Chemie 98:1061–1075

    CAS  Google Scholar 

  37. Thie Veterans Administration Systemic Sepsis Cooperative Study Group (1987) Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. N Engl J Med 317:659–665

    Article  Google Scholar 

  38. Tracey KJ, Beutler B, Lowry SF (1986) Shock and tissue injury induced by recombinant human cachectin. Science 234:470–474

    CAS  PubMed  Google Scholar 

  39. Tracey KJ, Fong Y, Hesse DG (1987) Anti-cachectin/TNF monoclonal antibodies prevent septic shock during lethal bacteraemia. Nature 330:662–664

    Article  CAS  PubMed  Google Scholar 

  40. Waage A, Halstensen A, Espevik T (1987) Association between tumour necrosis factor in serum and fatal outcome in patients with meningococcal disease. Lancet 1:355–357

    Article  CAS  PubMed  Google Scholar 

  41. Weitz JI, Landmann SL, Crowley KA, Birken S, Morgan FJ (1986) Development of an assay for in vivo human neutrophil elastase activity. J Clin Invest 78:155–162

    Article  CAS  PubMed  Google Scholar 

  42. Whimbey E, Kiehn TE, Brannon P, blevins A, Armstrong D (1987) Bacteremia and fungemia in patients with neoplastic disease. Am J Med 82:723–730

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Frauenklinik und Poliklinik der Technischen Universität rechts der Isar, München

    H. Graeff & R. Deckardt

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  1. H. Graeff
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  2. R. Deckardt
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Graeff, H., Deckardt, R. Blutung, Schock und Sepsis. Arch Gynecol Obstet 245, 801–817 (1989). https://doi.org/10.1007/BF02417573

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