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Verbesserung der Gewebeoxygenierung

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Intensivtherapie bei Sepsis und Multiorganversagen

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Zusammenfassung

Gewebehypoxie gilt als wichtiger Kofaktor der Pathogenese des Multiorganversagens [72]. Sie ist eine Folge der kardiozirkulatorischen Veränderungen, zu denen es durch die überschießende Mediatorenaktivierung kommt. Gleichzeitig ist davon auszugehen, daß Gewebehypoxie eine weitere aktivierende Wirkung auf die verschiedenen Mediator- und Kaskadensysteme hat. Einer adäquaten Gewebeoxygenierung kommt deshalb in der symptomatischen Therapie der Sepsis und des septischen Schocks eine zentrale Rolle zu, hierzu geeignete Strategien stehen deshalb im Mittelpunkt der intensivmedizinischen Maßnahmen. Folgende in Tabelle 11-1 aufgeführten Faktoren können zu einer unzureichenden Gewebeoxygenierung beim septischen Schock führen. Im septischen Schock sind somit nahezu alle Determinanten der zellulären O2-Versorgung beeinträchtigt (Tabelle 11-2). Diesmuß bei den therapeutischen Ansätzen mit berücksichtigt werden. Ziel muß es deshalb sein:

  1. 1.

    den globalen O2-Transport zu optimieren,

  2. 2.

    Mißverhältnisse zwischen regionalem O2-Verbrauch und regionalem O2-Angebot zu verhindern und

  3. 3.

    den Gas- und Substrataustausch auf der Ebene der Mikrozirkulation aufrechtzuerhalten.

Tabelle 11-1 Faktoren, die zu einer Beeinträchtigung der zellulären O2-Versorgung beim septi-schen Schock führen können
Full size table
Tabelle 11-2 Determinanten der zellulären O2-Versorgung
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  1. K. Reinhart
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  1. Städt. Krankenhaus Hildesheim Lehrkrankenhaus, Medizinischen Hochschule Hannover, Weinberg 1, 31134, Hildesheim, Deutschland

    Hans-Peter Schuster

  2. Klinikum Kröllwitz/Innere Medizin II, Martin-Luther-Universität, Ernst-Grube-Str. 40, 06097, Halle /Saale, Deutschland

    Karl Werdan

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Reinhart, K., Hüttemann, E. (2000). Verbesserung der Gewebeoxygenierung. In: Schuster, HP., Werdan, K. (eds) Intensivtherapie bei Sepsis und Multiorganversagen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-07962-1_11

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