Skip to main content
SpringerLink
Log in

Stressulkusprophylaxe und -therapie

  • Chapter
  • First Online:
NeuroIntensiv

  • 6950 Accesses

Zusammenfassung

Stressulzera sind Läsionen der Schleimhaut des oberen Gastrointestinaltraktes, die bei Intensivpatienten, insbesondere bei Polytraumen, Schädel-Hirn-Traumen und schweren Verbrennungen, gehäuft auftreten. Kommt es in diesem Zusammenhang zu klinisch relevanten Blutungen, d. h. zu Hämoglobin- und Blutdruckabfall, ist die Mortalität deutlich erhöht. Die Inzidenz klinisch bedeutsamer Blutungen ist jedoch gering (1,5 %), sodass bei weitem nicht alle Patienten einer Intensivstation eine Stressulkusprophylaxe benötigen. In jüngster Zeit mehren sich die Stimmen, die darauf hinweisen, dass H2-Rezeptorantagonisten und Protonenpumpeninhibitoren durch Anhebung des Magen-pH die Gefahr einer nosokomialen Pneumonie sowie einer Infekion mit Clostridium difficile erhöhen. Zu klären ist nun, welche Intensivpatienten eine medikamentöse Stressulkusprophylaxe erhalten sollten und welche nicht.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  1. American Society of Health-System Pharmacists (1999) ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. Am J Health-Syst Pharm 56:347–379

    Google Scholar 

  2. Cook DJ, Fuller H, Guyatt G, Marshall J, Leasa D, Winton D, Rutledge F, Tod TJR, Roy P, Lacroix J, Griffith L, Wilan A (1994) Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 330:377–381

    Article  CAS  PubMed  Google Scholar 

  3. Cook DJ, Reeve BK, Guyatt GH, Heyland DK, Griffith LE, Buckingham L, Tryba M (1996) Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analysis. JAMA 275:308–314

    Article  CAS  PubMed  Google Scholar 

  4. Cook DJ, Guyatt G, Marshall J, Leasa D, Fuller H, Hall R, Peters S, Rutledge F, Griffith L, McLellan A, Wood G, Kirby A (1998) A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. N Engl J Med 338:791–797

    Article  CAS  PubMed  Google Scholar 

  5. Cook DJ, Heyland D, Griffith L, Cook R, Marshall J, Pagliarello J (1999) Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation. Crit Care Med 27:2812–2817

    Article  CAS  PubMed  Google Scholar 

  6. Daley RJ, Rebuck JA, Welage LS, Rogers FB (2004) Prevention of stress ulceration: current trends in critical care. Crit Care Med 32:2008–2013

    Article  PubMed  Google Scholar 

  7. Faisy C, Guerot E, Diehl JL, Ivtimovici E, Fagon JY (2003) Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis. Intensive Care Med 29:1306–1313

    Article  PubMed  Google Scholar 

  8. Fennerty MB (2002) Pathophysiology of the upper gastrointestinal tract in the critically ill patient: Rationale for the therapeutic benefit of acid suppression. Crit Care Med 30(Suppl 1):351–355

    Article  Google Scholar 

  9. Herzig SJ, Howell MD, Ngo LH, Marcantonio ER (2009) Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA 301:2120–2128

    Article  CAS  PubMed  Google Scholar 

  10. Lasky MR, Metzler MH, Phillips JO (1998) A prospective study of omeprazole suspension to prevent clinically significant gastrointestinal bleeding from stress ulcers in mechanically ventilated trauma patients. J Trauma 44:527–533

    Article  CAS  PubMed  Google Scholar 

  11. Levy MJ, Seelig CB, Robinson NJ, Ranney JE (1997) Comparison of omeprazole and ranitidine for stress ulcer prophylaxis. Dig Dis Sci 42:1255–1259

    Article  CAS  PubMed  Google Scholar 

  12. Lu WY, Rhoney DH, Boling WB, Johnson JD, Smith TC (1997) A review of stress ulcer prophylaxis in the neurosurgical intensive care unit. Neurosurgery 41:416–425

    Article  CAS  PubMed  Google Scholar 

  13. Marik PE, Vasu T, Hirani A, Pachinburavan M (2010) Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Crit Care Med 38:2222–2228

    Article  PubMed  Google Scholar 

  14. Miano TA, Reichert MG, Houle TT, MacGregor DA, Kincaid EH, Bowton DL (2009) Nosocomial pneumonia risk and stress ulcer prophylaxis: a comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest 136:440–447

    Article  PubMed  Google Scholar 

  15. Pickworth KK, Falcone RE, Hoogeboom JE, Santanello SA (1993) Occurrence of nosocomial pneumonia in mechanically ventilated trauma patients: a comparison of sucralfate and ranitdine. Crit Care Med 21:1856–1862

    Article  CAS  PubMed  Google Scholar 

  16. Raff T, Germann G, Hartmann B (1997) The value of early enteral nutrition in the prophylaxis of stress ulceration in severely burned patient. Burns 23:313–318

    Article  CAS  PubMed  Google Scholar 

  17. Rosen HR, Vlahakes GJ, Rattner DW (1992) Fulminant peptic ulcer disease in cardiac surgical patients: pathogenesis, prevention and management. Crit Care Med 20:354–359

    Article  CAS  PubMed  Google Scholar 

  18. Tryba M, Cook D (1997) Current guidelines on stress ulcer prophylaxis. Drugs 54:581–59

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anaesthesiologie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    Jürgen Schneider Dr.

Authors
  1. Jürgen Schneider Dr.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jürgen Schneider Dr. .

Editor information

Editors and Affiliations

  1. Neurologische Klinik, Universitätklinikum Erlangen, Erlangen, Germany

    Stefan Schwab

  2. Neurologische Klinik und Geriatrie, Johannes Wesling Klinikum Minden, Minden, Germany

    Peter Schellinger

  3. Klinik für Anästhesiologie, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Germany

    Christian Werner

  4. Neurochirurgische Klinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany

    Andreas Unterberg

  5. Neurologische Klinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany

    Werner Hacke

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Schneider, J. (2015). Stressulkusprophylaxe und -therapie. In: Schwab, S., Schellinger, P., Werner, C., Unterberg, A., Hacke, W. (eds) NeuroIntensiv. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46500-4_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-46500-4_14

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-46499-1

  • Online ISBN: 978-3-662-46500-4

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation