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Intensivmedizin up2date 2013; 09(03): 233-248
DOI: 10.1055/s-0033-1344360
Neuro-Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Aktuelle Intensivtherapie der aneurysmatischen Subarachnoidalblutung

Berk Orakcioglu
,
Julian Bösel
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Publication Date:
23 July 2013 (online)

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Kernaussagen

  • Die Konsensusempfehlung der NCS liefert konkrete Handlungsvorschläge zur intensivmedizinischen Therapie der Subarachnoidalblutung.

  • Ziele sind eine schnellstmögliche Aneurysmaversorgung und die Verhinderung sekundärer Ischämien.

  • Zur Reduktion des Nachblutungsrisikos kann man bis zur Aneurysmaversorgung eine kurzzeitige antifibrinolytische Therapie mit Tranexamsäure erwägen.

  • Wichtig ist die Erkennung, Verhütung und Behandlung verzögerter zerebraler Ischämien.

  • Zur primären Therapie gehört eine Verbesserung der Hirndurchblutung durch eine induzierte Hypertonie.

  • Entgegen der jahrzehntelangen Praxis sind eine Hypervolämie und Hämodilution nicht mehr zu empfehlen.

  • Moderne endovaskuläre Verfahren sind in spezialisierten Zentren mit hinreichender Sicherheit als Notfalltherapie einsetzbar.

 

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