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01.03.2016 | Anästhetika | Leitthema

Kardioprotektion beim herzchirurgischen Patienten

Alles Gute kommt von Herzen

verfasst von: PD Dr. C. Stoppe, P. Meybohm, M. Coburn, A. Goetzenich

Erschienen in: Die Anaesthesiologie | Ausgabe 3/2016

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Zusammenfassung

Hintergrund

Trotz signifikanter Fortschritte in operativen Techniken, der Anästhesie und in der Intensivmedizin zeigen Patienten nach herzchirurgischen Eingriffen regelmäßig Organdysfunktionen mit bedeutenden klinischen Auswirkungen.

Fragestellung

Welche Strategien zur Kardioprotektion sind bei diesen gefährdeten Patienten mit einem klinischen Nutzen assoziiert?

Material und Methoden

Vorstellung der etablierten und neueren Strategien zum Schutz dieser Patienten, die gemeinsam zum Ziel haben, die körpereigenen protektiven Mechanismen zu nutzen.

Ergebnisse

Sowohl die Hypothermie als auch die Kardioplegie gehören zu den lang etablierten protektiven Strategien während myokardialer Ischämie. Die Applikation von volatilen Anästhetika zeigte bei Patienten mit herzchirurgischen Eingriffen eine signifikant verbesserte linksventrikuläre Funktion sowie eine reduzierte Myokardschädigung im Vergleich zur Kontrollgruppe mit intravenöser Anästhesie. Ebenso konnte eine verkürzte Aufenthaltsdauer auf der Intensivstation und im Krankenhaus nachgewiesen werden. Allerdings fehlen bis heute große randomisiert-kontrollierte Multicenter-Studien, die einen positiven klinischen Nutzen belegen. Die Translation von weiteren kardioprotektiven Strategien ist in der klinischen Anwendung bisher mehrheitlich gescheitert. Im Gegensatz zur initial demonstrierten Reduktion der Troponinfreisetzung nach Remote Ischemic Preconditioning konnte in den zuletzt publizierten großen Multicenter-Studien durch Fernkonditionierung kein Nutzen im Hinblick auf die klinischen Ergebnisse belegt werden.

Schlussfolgerung

Neben der Kardioplegie und Hypothermie hat sich der Gebrauch von volatilen Anästhetika aufgrund der konditionierenden und kardioprotektiven Eigenschaften fest etabliert. Bei weiteren vielversprechenden pharmakologischen Strategien ist die Translation der experimentellen Ergebnisse in die klinische Praxis bisher gescheitert. Weitere systematische Grundlagenforschung ist notwendig, um potenzielle Störfaktoren zu identifizieren.

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Titel: Kardioprotektion beim herzchirurgischen Patienten
Alles Gute kommt von Herzen
verfasst von: PD Dr. C. Stoppe
P. Meybohm
M. Coburn
A. Goetzenich
Publikationsdatum: 01.03.2016
Verlag: Springer Berlin Heidelberg
Schlagwörter: Anästhetika
Herzchirurgie
Herzchirurgie
Anästhetika
Erschienen in: Die Anaesthesiologie / Ausgabe 3/2016
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-016-0141-z

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