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Mikrozirkulationsstörung, zytopathische Hypoxie und septische Kardiomyopathie

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Sepsis und MODS

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Zusammenfassung

Der septische Schock ist mehr als nur ein Kreislaufschock der großen Gefäße! Die Mikrozirkulationsstörung mit Stase senkt die Prognose und ist derzeit keiner gezielten Therapie zugängig. Die therapierefraktäre „zytopathische Hypoxie“ trägt wesentlich zur Energieverarmung der Gewebe bei. Die potenziell reversible septische Kardiomyopathie wird wesentlich durch die diastolische Dysfunktion geprägt. Sie ist am besten mit dem nachlastbezogenen kardialen Herzzeitvolumen („afterload-related cardiac performance“, ACP) zu quantifizieren; die Schwere korreliert mit der Letalität. Die kardiale autonome Dysfunktion manifestiert sich als Herzfrequenzstarre und inadäquat hohe Herzfrequenz, teils erklärt durch die Endotoxin/Schrittmacherkanal(I f)-Interaktion. Die Therapie folgt der Standardtherapie des septischen Schocks, in Erprobung sind der Kalziumsensitizer Levosimendan, der kurzwirksame β-Blocker Esmolol (Senkung der inadäquat hohen Herzfrequenz) und der Schrittmacherkanalinhibitor Ivabradin.

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Authors and Affiliations

  1. Lehrstuhl für Geriatrie, Charité-Universitätsmedizin Berlin und Evangelisches Geriatriezentrum Berlin GmbH, Reinickendorfer Straße 61, 13347, Berlin, Deutschland

    Univ.-Prof. Dr. med. U. Müller-Werdan

  2. Klinik für Innere Medizin II, Katholisches Krankenhaus „St. Johann Nepomuk“, Haarbergstraße 72, 99097, Erfurt, Deutschland

    Prof. Dr. med. H. Ebelt

  3. Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 6120, Halle, Deutschland

    Dr. med. J. Wilhelm

  4. Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, St.-Marienkrankenhaus Siegen gem. GmbH, Kampenstraße 51, 57072, Siegen, Deutschland

    Dr. med. R. Wimmer

  5. Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, St.-Marienkrankenhaus Siegen gem. GmbH, Kampenstraße 51, 57072, Siegen, Deutschland

    Prof. Dr. med. M. Buerke

  6. Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 6120, Halle, Deutschland

    Prof. Dr. med. K. Werdan

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  1. Univ.-Prof. Dr. med. U. Müller-Werdan
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  2. Prof. Dr. med. H. Ebelt
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  3. Dr. med. J. Wilhelm
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  6. Prof. Dr. med. K. Werdan
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  1. Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle(Saale) der Martin-Luther-Universität Halle-Wittenberg, Halle(Saale), Germany

    Karl Werdan

  2. Lehrstuhl für Geriatrie, Charité-Universitätsmedizin Berlin und Evangelisches Geriatriezentrum Berlin gGmbH, Berlin, Berlin, Germany

    Ursula Müller-Werdan

  3. Hildesheim, Germany

    Hans-Peter Schuster

  4. Zentrum für Klinische Studien, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Germany

    Frank M. Brunkhorst

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Müller-Werdan, U., Ebelt, H., Wilhelm, J., Wimmer, R., Buerke, M., Werdan, K. (2016). Mikrozirkulationsstörung, zytopathische Hypoxie und septische Kardiomyopathie. In: Werdan, K., Müller-Werdan, U., Schuster, HP., Brunkhorst, F. (eds) Sepsis und MODS. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45148-9_9

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  • DOI: https://doi.org/10.1007/978-3-662-45148-9_9

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-45147-2

  • Online ISBN: 978-3-662-45148-9

  • eBook Packages: Medicine (German Language)

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