Metabolische Veränderungen bei Brandverletzten – Pathophysiologie und Therapie

Zusammenfassung

Brandverletzte sind in vielerlei Hinsicht ein spezielles Patientenkollektiv mit besonderen Anforderungen. Durch die Brandverletzung kommt es zu einer Störung physiologischer Abläufe. Unter anderem finden Veränderungen in der Regulation metabolischer Prozesse statt, welche im Vergleich zu anderen Traumata wesentliche Unterschiede aufweisen. In diesem Review gehen wir zuerst auf die metabolische Pathophysiologie des Verbrennungstraumas ein, um danach die klinische Relevanz einer adäquaten metabolischen Regulation zu erörtern und zuletzt Therapieansätze zu präsentieren.

Abstract

Compared to other trauma patients, burn trauma victims show alterations that require special attention. The burn trauma modifies several physiologic processes. Metabolic regulation presents itself as one of the major problems. The first part of this review deals with the metabolic pathophysiology of severe burn trauma and its clinical impact. At the end we present possible therapeutic interventions with their mode of action and common side effects.

Schlüsselwörter:

Metabolismus - Verbrennungstrauma - Hyperglykämie - Intensivmedizin - Outcome

Keywords:

metabolism - burn trauma - hyperglycemia - intensive care - outcome

Kernaussagen

• Die Akutphase bei Schwerbrandverletzten geht mit einer gesteigerten Glykogenolyse und Lipolyse einher.

• In der chronischen Phase kommt es zur Ausbildung einer peripheren Insulinresistenz.

• Einlagerungen von FFS in Muskeln und Leber führen zu einer Verstärkung der Insulinresistenz.

• Die Hyperglykämie führt zu Wundheilungsstörungen, einer erhöhten Infektrate und einer gesteigerten Mortalität.

• Eine engmaschige Kontrolle und die Einstellung des Blutzuckerspiegels sind unerlässlich.

• Die Insulingabe steht bei der Einstellung des Blutzuckerspiegels im Vordergrund.

• Andere Therapieformen wie Beta–Rezeptorblockade oder Oxandrolon können individuell herangezogen werden.

• Eine enterale Ernährung sollte so rasch wie möglich begonnen und entsprechend der Darmfunktion gesteigert werden.

• Des Weiteren ist darauf zu achten, dass der Kalorienbedarf des Patienten ausreichend gedeckt ist.

• Die Umgebungstemperatur sollte adäquat eingestellt werden.

• Eine frühe Mobilisierung hat prognostisch positive Auswirkungen.

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