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Die Anaesthesiologie

Erschienen in:

01.08.2009 | Leitthema

Hämodynamisches Monitoring in der perioperativen Phase

Verfügbare Systeme, praktische Anwendung und klinische Daten

verfasst von: U. Wittkowski, C. Spies, M. Sander, J. Erb, A. Feldheiser, Prof. Dr. C. von Heymann, DEAA

Erschienen in: Die Anaesthesiologie | Ausgabe 8/2009

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Zusammenfassung

Ein regulärer Hydratationsstatus und Normovolämie sind Ziele der intra-/perioperativen Flüssigkeits- sowie Volumentherapie und gleichzeitig Voraussetzungen für eine adäquate Hämodynamik zur Sicherstellung einer ausreichenden Gewebeoxygenierung. Die physiologischen und pathophysiologischen Effekte der Flüssigkeits- und Volumentherapie beruhen auf den pharmakologischen Eigenschaften der verwendeten Infusionslösung, dem applizierten Volumen und – nach neueren Erkenntnissen – auch auf dem Zeitpunkt der Flüssigkeitsgabe. In der perioperativen Phase unterliegt der Organismus den hormonellen Bedingungen der metabolischen Stressantwort, die neben den perioperativen Änderungen der Gefäßpermeabilität zu berücksichtigen sind. Das Ziel des hämodynamischen Monitorings im OP ist es, Informationen über die Hämodynamik und das globale Sauerstoffangebot zu gewinnen, die eine Abschätzung des intravasalen Volumenstatus des Patienten erlauben. Dies kann die Volumen- und Flüssigkeitstherapie im Sinne einer Konstanthaltung des Herzzeitvolumens verbessern, das vor allen Dingen für Risikopatienten relevant ist. Eine verbesserte und hypovoläme Zustände vermeidende Volumentherapie kann das postoperative Outcome der Patienten positiv beeinflussen. Ziel dieser Arbeit ist es, dem Leser einen Überblick über die aktuell im klinischen Alltag zur Verfügung stehenden Monitoringverfahren zur Einschätzung des perioperativen Volumenstatus zu geben; hierzu werden jeweils das Messprinzip, die Messparameter sowie die Vor- und Nachteile des jeweiligen Verfahrens dargestellt. Weiter wird diskutiert, welche Monitoringverfahren in klinischen Studien schon zur zielgerichteten perioperativen Flüssigkeits- und Volumentherapie („goal-directed therapy“) untersucht wurden.

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Titel: Hämodynamisches Monitoring in der perioperativen Phase
Verfügbare Systeme, praktische Anwendung und klinische Daten
verfasst von: U. Wittkowski
C. Spies
M. Sander
J. Erb
A. Feldheiser
Prof. Dr. C. von Heymann, DEAA
Publikationsdatum: 01.08.2009
Verlag: Springer-Verlag
Erschienen in: Die Anaesthesiologie / Ausgabe 8/2009
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-009-1590-4

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Hämodynamisches Monitoring in der perioperativen Phase

Verfügbare Systeme, praktische Anwendung und klinische Daten

Zusammenfassung

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