Skip to main content

Möglichkeiten zur Verbesserung einer gestörten Splanchnikusperfusion

  • Conference paper
Refresher Course Aktuelles Wissen für Anästhesisten

Part of the book series: Refresher Course Aktuelles Wissen für Anästhesisten ((REFRESHER COUR,volume 23))

  • 38 Accesses

Zusammenfassung

Trotz Erweiterung therapeutischer und diagnostischer Möglichkeiten ist auch heute noch das Multiorganversagen eine der häufigsten Todesursachen bei Intensivpatienten. Die symptomatische Behandlung der erkrankten Einzelorgane, gestützt durch ein teils invasives Monitoring, war häufig der Hauptansatz in der Behandlung dieses komplexen Krankheitsbildes. Die unverändert hohe Mortalität bei Multiorganversagen wurde in der APACHE III Studie belegt [1]. Dort wurde nachgewiesen, daß keine nennenswerten Veränderungen bezüglich Inzidenz und Outcome bei Multiorganversagen gegenüber der 1985 durchgeführten APACHE II Studie erreicht wurden.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Knaus WA, Wagner DP, Draper EA (1991) The APACHE III prognosis system: Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100: 1619–1631

    Article  PubMed  CAS  Google Scholar 

  2. Meakins JL, Marshall JC (1989) The gut as the motor of multiple system organ failure. In: Marston A, Bulkley GB, Fiddian-Green RG et al (eds) Splanchnic ischaemia and multiple organ failure. London: Edwart Arnold, pp 339–348

    Google Scholar 

  3. Gimson AES (1987) Hepatic dysfunction during bacterial sepsis. Intensive Care Med 13: 162–166

    Article  PubMed  CAS  Google Scholar 

  4. Michie HR, Guilluon PJ, Wilmore DW (1989) Tumor necrosis factor and bacterial sepsis. Br J Surg 76: 670–671

    Article  PubMed  CAS  Google Scholar 

  5. Maynard N, Bihari D, Beale R et al (1993) Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA 270: 1203–1210

    Article  PubMed  CAS  Google Scholar 

  6. Lautt WW, Legare DJ, Ezzat WR (1990) Quantitation of hepatic arterial buffer response to graded changes in portal blood flow. Gastroenterology 98: 1024–1028

    Article  PubMed  CAS  Google Scholar 

  7. Kawada N, Tran-Thi T-A, Klein H, Decker K (1993) The contraction of hepatic stellate (ito) cells stimulated with vasoactive substances possible involvement of endothelin 1 and nitric oxide in the regulation of the sinusoidal tonus. Eur J Biochem 213: 815–823

    Article  PubMed  CAS  Google Scholar 

  8. Fink MP (1991) Gastrointestinal mucosal injury in experimental models of shock, trauma, and sepsis. Crit Care Med 19: 627–641

    Article  PubMed  CAS  Google Scholar 

  9. Lundgren O, Haglund U (1978) The pathophysiology of the intestinal countercurrent exchanger. Life Sciences 23: 1411–1422

    Article  PubMed  CAS  Google Scholar 

  10. Bohlen HG (1980) Intestinal tissue PO2 and microvascular response during glucose exposure. Am J Physiol 238: H 164–H 171

    Google Scholar 

  11. Dalen JE, Bone RC (1996) Is it time to pull the pulmonary artery catheter? JAMA 276: 916–918

    Article  PubMed  CAS  Google Scholar 

  12. Bowles SA, Schlichtig R, Klions HA (1992) The supply-dependent intestine does not produce lactate during progressive flow stagnation. Am Rev Respir Dis 154: A792

    Google Scholar 

  13. Kainuma M Nakashima K, Sakuma I, Kawase M, Komatsu T, Shimada Y, Nimura Y, Nonami T (1992) Hepatic venous hemoglobin oxygen saturation predicts liver dysfunction after hepatectomy. Anesthesiology 76: 379–386

    Article  PubMed  CAS  Google Scholar 

  14. Arnold J, Hendriks J, Ince C, Bruining H (1994) Tonometry to assess the adequacy of splanchnic oxygenation in the critically ill patient. Intensive Care Med 20: 452–456

    Article  PubMed  CAS  Google Scholar 

  15. Fiddian-Green RG (1982) Back diffusion of CO2, and its influence on the intramural pH in gastric mucosa. J Surg Res 33: 39–48

    Article  PubMed  CAS  Google Scholar 

  16. Ivatury RR, Simon RJ, Havriliak D, Garcia C, Greenbarg J, Stahl WM (1995) Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resucitation after trauma: a prospective, randomized study. Journal of Trauma 39: 128–136

    Article  PubMed  CAS  Google Scholar 

  17. Knichwitz G (1996) A new method for continuous intramucosal PCO2 measurement in the gastrointestinal tract. Anesth Analg 83: 6–11

    PubMed  CAS  Google Scholar 

  18. Shoemaker WC (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186

    Article  PubMed  CAS  Google Scholar 

  19. Gattionini L (1995) A trial goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333: 1025–1032

    Article  Google Scholar 

  20. Edouard AR, Degremont A-C, Duranteau J, Pussard E, Berdeaux A, Samii K (1994) Heterogenous regional vascular responses to simulated transient hypovolemia in man. Intensive Care Med 20: 414–420

    Article  PubMed  CAS  Google Scholar 

  21. Mythen MG, Webb AR (1994) The role of gut mucosal hypoperfusion in the pathogenesis of postoperative organ dysfunction. Intensive Care Med 20: 203–209

    Article  PubMed  CAS  Google Scholar 

  22. Kainuma M, Kimura N, Nonami T, Kurokawa T, Ito T, Nakashima K et al (1992) Effect of dobutamine on hepatic blood flow and oxygen supply-uptake ratio during enflurane nitrous oxide anesthesia in humans undergoing liver resection. Anesthesiology 77: 432–438

    Article  PubMed  CAS  Google Scholar 

  23. Roytblat L, Gelman S, Bradley EL, Henderson T, Park D (1990) Dopamine and hepatic oxygen supply-demand relationship. Can J Physiol Pharmacol 68: 1165–1169

    Article  PubMed  CAS  Google Scholar 

  24. Hirsch LJ, Ayabe T, Glick D (1976) Direct effects of various catecholamines on liver circulation in dogs. Am J Physiol 77: 432–438

    Google Scholar 

  25. Priebe H-J, Nöldge GFE, Armbruster K, Geiger K (1995) Differential effects of dobutamine, dopamine, and noradrenaline on splanchnic haemodynamics and oxygenation in the pig. Acta Anaesthesiol Scand 39: 1088–1096

    Article  PubMed  CAS  Google Scholar 

  26. Moss R, Tighe D, Haywood GA et al (1990) The differening effects of dopexamine, dobutamine and placebo on the histology of the liver in pig peritonitis. Intensive Care Med 16 (Suppl. 1): 66

    Google Scholar 

  27. Fink MP, Rothschild R, Deniz YF, Wang H, Lee PC, Cohn SM (1989) Systemic and mesenteric O2 metabolism in endotoxin pigs: effect of ibuprofen and meclofenamate. J Appl Physiol 67: 1950–1957

    PubMed  CAS  Google Scholar 

  28. Zhang H, Spapen H, Nguyen DN, Rogiers P, Bakker J, Vincent JL (1995) Effects of N-acetyl- L-cysteine in regional blood flow during endotoxic shock. Eur J Surg 9: 236–243

    Google Scholar 

  29. Leyer CV (1988) Regional blood flow responses to vasodilators and inotropes in congestive heart failure. Am J Cardiol 62: 86E–93E

    Article  Google Scholar 

  30. Spain DA, Wilson MA, Bar-Natan MD, Garrison RN (1994) Nitric oxide synthase inhibition aggravates intestinal microvascular vasoconstriction and hypoperfusion of bacteremia. J Trauma 36: 720–725

    Article  PubMed  CAS  Google Scholar 

  31. Johansson K, Ahn H, Lindhagen J, Tryselius U (1988) Effect of epidural anaesthesia on intestinal blood flow. Brit J Anaesth 75: 73–76

    CAS  Google Scholar 

Download references

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 1996 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Nöldge-Schomburg, G., Goepfert, A. (1996). Möglichkeiten zur Verbesserung einer gestörten Splanchnikusperfusion. In: Refresher Course Aktuelles Wissen für Anästhesisten. Refresher Course Aktuelles Wissen für Anästhesisten, vol 23. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-80367-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-80367-3_5

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-62552-0

  • Online ISBN: 978-3-642-80367-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics