Gastrointestinale Motilitätsstörungen auf der Intensivstation – Ursachen, Konsequenzen und Therapie

 

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Zusammenfassung

Eine intakte Funktion des Gastrointestinaltrakts (GIT) ist für die Prognose von Intensivpatienten von wesentlicher Bedeutung. Störungen der gastrointestinalen Motilität, wie sie durch viele Medikamente, überschießende Flüssigkeitstherapie, Beatmung mit hohem PEEP oder durch chirurgische oder ischämische Darmwandläsionen im Rahmen von SIRS und Sepsis auftreten, können zu Problemen bei enteraler Ernährung, zu Defekten der gastrointestinalen Barrierefunktion und damit zur Verschlechterung der Gesamtprognose kritisch kranker Patienten beitragen. Neben rechtzeitiger Diagnose und individueller problemorientierter Therapie sind vor allem frühzeitige Prophylaxemaßnahmen wichtig.

Abstract

Maintaining regular function of the intestinal tract is an important prerequisite for successful outcomes in critical illness. Disturbances of gastrointestinal motility are frequently caused by drugs, excessive fluid load, mechanical ventilation, surgical or ischemic damage, and occur frequently in sepsis and SIRS. Impaired gastrointestinal motility may give rise to a vitious circle of enteral nutrition intolerance, edema, and may eventually result in a breakdown of the gastrointestinal barrier. Early diagnosis, patient-adapted treatment and a focus on prophylactic measures are necessary prerequisites to maintain gut function in critically ill patients.

Kernaussagen

• Der Darm ist das größte immunologische Organ des Menschen. Störungen der gastrointestinalen Motilität können von Entzündungen bis hin zur Sepsis führen.

• Intensivpatienten haben aufgrund ihres Zustands ein erhöhtes Risiko für gastrointestinale Motilitätsstörungen.

• Einfache klinische Untersuchungen wie Auskultation, Palpation und Perkussion sollten auf Intensivstationen routinemäßig durchgeführt werden.

• Bei spezifischen Fragestellungen stehen weitere Möglichkeiten wie Röntgen, CT, Koloskopie bis hin zur chirurgischen Exploration zur Verfügung.

• Auch auf Intensivstationen ist eine rasche Herstellung der Autonomie des Patienten wichtig. Frühe Mobilisation und frühe enterale Ernährung wirken sich positiv auf die Genesung aus.

• Die beste Therapie gegen Motilitätsstörungen ist immer noch die Prophylaxe:

  • Verwenden Sie Opiate so wenig und kurzzeitig wie möglich.

  • Vermeiden Sie massive Kristalloid- oder Kolloidinfusionen, da sie die Bildung von Darmwandödemen begünstigen.

  • Anästhesieverfahren sollten so gewählt werden, dass der Patient schnell mobilisierbar wird.

• Peristaltikfördernde Medikamente wie Laxanzien, Opiatrezeptoragonisten und Prokinetika können einzeln oder in Kombination verabreicht werden.

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Dr. med. Joanna Stefaniak
Univ.-Ass. Dr. med. David Baron
Prof. Dr. med. Philipp Metnitz
Univ-Prof. Dr. med. Ludwig Kramer

Email: joanna.stefaniak@meduniwien.ac.at

Email: david.baron@meduniwien.ac.at

Email: philipp.metnitz@meduniwien.ac.at

Email: ludwig.kramer@wienkav.at

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