Kriterien der Operabilität View Full Text


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Article Info

DATE

2007-09

AUTHORS

C. Waydhas, S. Flohe

ABSTRACT

Die pathophysiologischen Abläufe nach akzidentellem Trauma zeigen einen phasischen Verlauf der immunmodulatorischen Reaktion. Ein operatives Trauma durch eine sekundäre Operation stellt hierbei eine zusätzliche Noxe dar. Je nachdem, in welcher Phase der posttraumatischen Inflammation dieser Second Hit einwirkt, können mehr oder weniger starke Störungen der Homöostase bis hin zum postoperativen Multiorganversagen auftreten. Größere sekundäre Operationen innerhalb der ersten 2–3 Tage nach dem Trauma scheinen ein deutlich größeres Operationsrisiko aufzuweisen und sollten – sofern keine dringliche Indikation besteht – auf einen späteren Zeitpunkt verschoben werden, insbesondere wenn die Lungenfunktion eingeschränkt ist (pO2/FiO2-Quotient<280 mmHg). Für die Planung von Operationen ab dem 4. Tag scheinen ein pO2/FiO2-Quotient>280 mmHg, eine stabile Kreislaufsituation, eine Thrombozytenzahl >100.000–150.000/µl und steigende globale Gerinnungstests im Referenzbereich, eine moderate Inflammation (C-reaktives Protein, Interleukin-6), eine ausgeglichene Flüssigkeitsbilanz und bei Schädel-Hirn-Trauma ein Hirndruck <15–20 mmHg oder fehlende Hirndruckzeichen im CCT ein akzeptables Operationsrisiko anzuzeigen. More... »

PAGES

177-181

Journal

TITLE

Trauma und Berufskrankheit

ISSUE

3

VOLUME

9

Author Affiliations

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10039-007-1246-z

DOI

http://dx.doi.org/10.1007/s10039-007-1246-z

DIMENSIONS

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