Zusammenfassung
Seitdem erste klinische Studien erhebliche Auswirkungen unterschiedlicher Infusionsregime
auf die Morbidität und Letalität gezeigt haben, gewinnt die perioperative Flüssigkeitstherapie
zunehmend an Bedeutung. Dennoch orientiert sich die tägliche Praxis häufig noch an
Gewohnheiten oder „Expertenmeinungen”. Ein adäquates Flüssigkeitsmanagement beinhaltet
die Substitution von Verlusten sowie die kausale Therapie von Störungen des Flüssigkeitshaushalts.
Dabei müssen die Zielwerte der Verlaufsparameter für den jeweiligen Patienten individuell
festgelegt werden. Aktuelle Studien empfehlen perioperativ bei elektiven Eingriffen
am Gastrointestinaltrakt eine restriktive Flüssigkeitsgabe zur Verbesserung des Outcomes.
Im Falle einer schweren Sepsis oder eines septischen Schocks führt dagegen eine frühzeitige
und aggressive Volumentherapie zu einer Senkung der Letalität.
Die große Anzahl von Flüssigkeits- und Volumenersatzmitteln ermöglicht einerseits
eine differenzierte Therapie, kann andererseits aber auch zu einem Übersichtsverlust
beitragen. Besonders hervorzuheben sind zum einen die neuen, balancierten Infusionslösungen,
die aufgrund verminderter Störungen des Säure-Basen-Haushalts wahrscheinlich zu bevorzugen
sind. Zum anderen sollte man die aktuelle Diskussion um die Anwendung von Hydroxyethylstärke-Lösungen
(HES-Lösungen) vor dem Hintergrund führen, dass für die isoonkotischen HES-Lösungen
der dritten Generation (im Gegensatz zu den klassischen hyperonkotischen Präparaten)
bis dato keine nephrotoxischen Effekte nachgewiesen worden sind.
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Dr. med. Sebastian Rehberg
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin
Albert-Schweitzer-Straße 33
48149 Münster
Email: Sebastian_Rehberg@web.de
