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Medizinische Klinik - Intensivmedizin und Notfallmedizin

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01.02.2016 | Übersichten

Katecholamine: Pro und Kontra

verfasst von: Prof. Dr. R. Riessen, O. Tschritter, U. Janssens, M. Haap

Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin | Ausgabe 1/2016

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Zusammenfassung

Hintergrund

Katecholamine als vasopressorisch und inotrop wirksame Substanzen gehören zu den am häufigsten in der Intensivmedizin eingesetzten Medikamenten. Ziel dieser Übersicht ist es, neben den physiologischen Grundlagen einer Katecholamintherapie besonders auch die Risiken darzustellen, die sich aus einer unkritischen und übermäßigen Gabe dieser Substanzen ergeben können.

Ungünstige Wirkungen

Im Mittelpunkt steht dabei eine durch eine adrenerge Überstimulation ausgelöste Schädigung des Herzens. Es gibt deutliche Hinweise dafür, dass bei schwerer Herzinsuffizienz, bei Myokardischämien sowie im kardiogenen und septischen Schock speziell der Einsatz von Katecholaminen mit stärkerer β-adrenerger Wirkung (Adrenalin, Dobutamin, Dopamin) ungünstige Wirkungen haben kann. Als einfacher Risikomarker für eine kardiale Schädigung ist dabei eine Tachykardie anzusehen.

Anwendung

Eine individuell an Perfusionsparametern (z. B. Urinausscheidung, Laktat) ausgerichtete Therapie mit Vasopressoren, wie Noradrenalin, erscheint dagegen bei den verschiedenen Formen des Schocks sowie bei hämodynamischer Instabilität im Rahmen einer tiefen Analgosedierung als gerechtfertigt. Im Sinne einer kardioprotektiven Therapie sollte der Einsatz von Katecholaminen jedoch grundsätzlich immer wieder hinterfragt und auf ein als notwendig erachtetes Minimum titriert werden.

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Titel: Katecholamine: Pro und Kontra
verfasst von: Prof. Dr. R. Riessen
O. Tschritter
U. Janssens
M. Haap
Publikationsdatum: 01.02.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin / Ausgabe 1/2016
Print ISSN: 2193-6218
Elektronische ISSN: 2193-6226
DOI: https://doi.org/10.1007/s00063-015-0011-5

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