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Klin Padiatr 2003; 215(1): 16-21
DOI: 10.1055/s-2003-36890
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© Georg Thieme Verlag Stuttgart · New York

Was ist beim Frühgeborenen ein ausreichender Blutdruck?

Ausreichender Blutdruck bei FrühgeborenenWhat is a Sufficient Blood Pressure in the Preterm Newborn?H.  Stopfkuchen1
  • 1Universitätskinderklinik Mainz
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Publication History

Publication Date:
24 January 2003 (online)

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Zusammenfassung

Bei einem hohen Prozentsatz von sehr unreifen Frühgeborenen wird insbesondere in den ersten 24 Lebensstunden die Diagnose einer arteriellen Hypotension gestellt und eine antihypotensive Behandlung eingeleitet. Dabei gibt es bis heute keine gesicherte Antwort auf die Frage, welcher Blutdruckwert im konkreten Fall wirklich als zu niedrig zu bewerten ist. Das diesbezügliche praktische Vorgehen im klinischen Alltag orientiert sich üblicherweise entweder an vorliegenden Referenzwerten oder erfolgt nach klinischen Gesichtspunkten. Zu den bei nicht stärker beeinträchtigten Frühgeborenen gewonnenen Referenzwerten, die insbesondere im Umgang mit klinisch eher stabilen Frühgeborenen Berücksichtigung finden, zählen üblicherweise alters- bzw. gewichtsbezogene „Normalwerte” und „Daumenregeln”, während den zerebralen Autoregulationsbereich berücksichtigende bzw. prognoseorientierte Blutdruckwerte dazu denkbare Alternativen sein könnten. Klinische Symptome, laborchemische Befunde sowie kardiale Funktionsparameter können als Kriterien dafür herangezogen werden, ob ein bestehender Blutdruck ausreicht, um eine Mindestperfusion zu gewährleisten. In dieser insgesamt wenig befriedigenden Situation setzt sich aber auch in der Patientengruppe der Frühgeborenen zunehmend die Erkenntnis durch, dass nicht der leicht messbare Blutdruck, sondern der allerdings viel schwieriger zu ermittelnde systemische bzw. regionale Blutfluss die entscheidende hämodynamische Messgröße ist, und dass auch bei Frühgeborenen zwischen Blutdruck und Herzzeitvolumen bzw. regionalem Blutfluss allenfalls schwache Korrelationen bestehen.

Abstract

Hypotension is diagnosed in a high percentage of very low birth weight infants, particularly in the first 24 hours after birth and the resultant clinical approach is to support the blood pressure vigorously. However, the research base is not yet available to give a definite answer to the question, which blood pressure is really unacceptable in a given clinical situation. The clinical approach usually relies on reference blood pressure data or on clinical considerations. Reference blood pressure ranges established from observations of rather stable preterm infants and commonly used in “normal” premature infants are age- and weight related so-called “normal” blood pressures and “rules of thumb” while cerebral autoregulation adapted or outcome related lower limits of arterial blood pressure could be promising alternatives. Clinical signs, results of laboratory studies and cardiac function monitoring are tools used in stable and unstable premature infants for assessing if an acute blood pressure is adequate to prevent tissue malperfusion. In this rather unsatisfactory situation there is a growing body of evidence that also in premature infants systemic or regional blood flow and not blood pressure are the crucial hemodynamic parameters and that also in this age group there is at best a weak correlation between mean arterial blood pressure and left ventricular output or regional blood flow.




Schlüsselwörter

Frühgeborene - Blutdruck

Key words

Premature infants - blood pressure

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Univ.-Prof. Dr. Herwig Stopfkuchen

Universitäts-Kinderklinik

Langenbeckstraße 1

55101 Mainz

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