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Therapie des infarktbedingten kardiogenen Schocks

Treatment of infarction-related cardiogenic shock

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Zusammenfassung

Der infarktbedingte kardiogene Schock – meist die Folge eines linksventrikulären Pumpversagens – hat mit einer Sterblichkeit von 50–80% weiterhin eine schlechte Prognose. Therapieentscheidend ist die möglichst frühzeitige Wiedereröffnung des verschlossenen Koronargefäßes. Die Schockbehandlung beinhaltet die medikamentöse Herz-Kreislauf-Therapie mit Dobutamin als Inotropikum und Noradrenalin als Vasopressor der Wahl, gesteuert anhand einer Kombination von Druck- und Flussparametern, z. B. einem mittleren Blutdruck von 65–75 mmHg und einem Herzindex > 2,5 l/min/m2. Die bestmögliche Therapie des kardiogenen Schocks beinhaltet zudem die intensivmedizinischen Maßnahmen zur Vermeidung bzw. Behandlung des Multiorgandysfunktionssyndroms.

Abstract

Infarction-related cardiogenic shock, which is usually a result of left ventricular failure, still has a poor prognosis with a mortality rate of 50–80%. A crucial factor for therapy is the earliest possible reopening of the occluded coronary artery. The medical treatment of shock includes cardiovascular therapy with dobutamine as an inotrope and norepinephrine as a vasopressor of choice, guided by the combination of pressure and flow parameters (e.g. mean blood pressure 65–75 mmHg and cardiac index > 2.5 l/min/m2). The best available therapy of cardiogenic shock includes intensive medical therapeutic measures for the prevention and treatment of multiple organ dysfunction syndrome (MODS).

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: M. Ruß: keine. K. Werdan hat Vortragshonorare von den Fa. Baxter, Datascope, Maquet und Orion erhalten, in Advisory Boards der Fa. Baxter und Datascope mitgearbeitet und Forschungsunterstützung von der Fa. Datascope erhalten. M. Buerke hat Vortragshonorare der Firmen Datascope und Orion erhalten.

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Authors and Affiliations

  1. Klinik für Innere Medizin I, Klinikum Dachau, Amperkliniken AG, Krankenhausstr. 15, 85221, Dachau, Deutschland

    M. Ruß

  2. Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland

    M. Buerke

  3. Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland

    K. Werdan

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  1. M. Ruß
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  2. M. Buerke
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  3. K. Werdan
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Correspondence to M. Ruß.

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Ruß, M., Buerke, M. & Werdan, K. Therapie des infarktbedingten kardiogenen Schocks. Notfall Rettungsmed 15, 445–456 (2012). https://doi.org/10.1007/s10049-012-1627-0

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