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Therapie des hämorrhagischen Schocks

Neue Strategien auf der Basis experimenteller Daten

Therapy of hemorrhagic shock

New strategies based on experimental results

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Zusammenfassung

Die etablierte Therapie des hämorrhagischen Schocks besteht heute in einer raschen Blutungskontrolle, Erhalt der Sauerstoffversorgung des Gewebes durch Volumentherapie, der Gerinnungstherapie sowie dem Erhalt einer normalen Körpertemperatur. Dennoch existieren große Unterschiede in der Flüssigkeits- und Blutersatztherapie in den verschiedenen Institutionen. Wesentliche Ursachen hierfür sind das Fehlen von evidenzbasierten Daten, welches aufgrund der großen ethischen und rechtlichen Hürden die Initiierung von randomisierten, kontrollierten Studien erschwert. Dies ist einer der Hauptgründe, warum neue Therapieansätze, welche sich vor allem auf experimentelle Daten stützen, zu keinen wesentlichen Änderungen in der etablierten Therapie geführt haben.

Dieser Übersichtsartikel erläutert neue diagnostische und therapeutische Strategien unter Einbeziehung eines immunologisches Monitoring, neuer Wirkstoffe zum Erhalt der Herz-Kreislauf-Funktion, künstlicher Sauerstoffträger als Blutersatz und neue Flüssigkeitssubstitutionsregime, die aufgrund vielversprechender experimenteller Ergebnisse Einzug in die Klinik gehalten haben oder halten werden. Zusätzlich wird auf die Bedeutung von Alter, Geschlecht und genetischen Faktoren hingewiesen.

Abstract

Despite numerous promising experimental results control of bleeding, maintenance of tissue oxygenation by means of fluid replacement, support of the coagulation system and sustainment of normothermia are mainstays in the therapy of patients in hemorrhagic shock. Regimens for volume and blood replacement, however, vary widely between trauma centers due to the lack of evidence-based publications referring to randomized controlled clinical trials. Ethical and legal requirements for the inclusion of patients with hemorrhagic shock in clinical trials have impeded the rapid introduction of experimental strategies in the clinical arena.

This review article will point out new therapeutic strategies, i.e. immunomodulation, cardiovascular maintenance, use of artificial oxygen carrying substances and new formulae for volume substitution, which have been introduced into clinical therapy or are in the process of being transformed from bench to bedside. In addition, the impact of gender, age and genetics on cardiovascular and immune responses will be reflected.

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik der Universität München Campus Großhadern, Ludwig-Maximilians Universität München, Marchioninistr. 15, 81377, München, Deutschland

    C.P. Schneider, E. Faist &  M.K. Angele

  2. Center for Surgical Research, Department of Surgery, University of Alabama at Birmingham, AL, Birmingham, USA

    I.H. Chaudry

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  1. C.P. Schneider
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  2. E. Faist
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  3. I.H. Chaudry
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  4. M.K. Angele
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Correspondence to M.K. Angele.

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Schneider, C., Faist, E., Chaudry, I. et al. Therapie des hämorrhagischen Schocks. Notfall Rettungsmed 12, 193–200 (2009). https://doi.org/10.1007/s10049-008-1147-0

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