Zusammenfassung
Blutungen und Gerinnungsstörungen sind beim Traumapatienten nicht selten und erfordern eine frühzeitige und konsequente Therapie. Unter den oft vorherrschenden pathophysiologischen Bedingungen beim schweren Trauma wie Hypothermie, Azidose und Koagulopathie stellt Desmopressin eine mögliche Option bei der Behandlung von diffusen Blutungen dar. Wir berichten über 2 Patienten, die nach schwerem Trauma diffus bluteten und bei denen aus Sicht der Autoren nach der Desmopressingabe die Blutung deutlich nachließ beziehungsweise sistierte. Weiterhin wird der mögliche Nutzen von Desmopressin bei diesen Patienten diskutiert.
Abstract
Bleeding and clotting disturbances are not uncommon in trauma patients and require an early and consequent therapy. Under the prevalent pathophysiological circumstances of hypothermia, acidosis and clotting disturbances, desmopressin seems to be a possible option to control diffuse bleeding. We report about 2 trauma patients with diffuse bleeding and in whom desmopressin was used successfully to control bleeding from the point of view of the authors. We discuss the advantages and disadvantages of desmopressin in the 2 patients.
Schlüsselwörter
Trauma - Blutung - Gerinnungsstörungen - Desmopressin - Azidose - Hypothermie
Key words
trauma - bleeding - clotting disturbances - desmopressin - acidosis - hypothermia
Literatur
-
1
Hilbert P, zur Nieden K, Hofmann G O et al.
New aspects in the emergency room management of critically injured patients: a multi-slice CT-oriented care algorithm.
Injury.
2007;
38
552-558
-
2 Heindl B et al. Gerinnungsmanagement bei perioperativen Blutungsnotfall. 1 Aufl. Bremen, London, Boston; UNI-MED 2008
-
3
Cosgriff N, Moore E E, Sauaia A et al.
Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited.
J Trauma.
1997;
42
857-861
-
4
Meng Z H, Wolberg A S, Monroe III D M et al.
The effect of temperature and pH on the activity of factor VII a: implications for the efficacy of high-dose factor VII a in hypothermic and acidotic patients.
J Trauma.
2003;
55
886-891
-
5
Wolberg A S, Meng Z H, Monroe III D M et al.
A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function.
J Trauma.
2004;
56
1221-1228
-
6
Grottke O, Rossaint R.
[Procedure for critical nonsurgical bleeding].
Chirurg.
2007;
78
101-109
-
7
Ying C L, Tsang S F, Ng K F.
The potential use of desmopressin to correct hypothermia-induced impairment of primary haemostasis – an in vitro study using PFA-100.
Resuscitation.
2008;
76
129-133
-
8
Lethagen S.
Desmopressin – a haemostatic drug: state-of-the-art review.
Eur J Anaesthesiol Suppl.
1997;
14
1-9
-
9
Manco-Johnson M.
Therapie der Thrombozytopathien.
Die gelben Hefte.
2001;
41
78-85
-
10
Coppula A, Di Minno G.
Desmopressin in inherited disorders of platelet function.
Haemophilia.
2008;
14 (Suppl. 1)
31-39
-
11
Cattaneo M.
The use of desmopressin in open-heart surgery.
Haemophilia.
2008;
14 (Suppl. 1)
40-47
-
12
Spahn D R, Cerny V, Coats T J et al.
Management of bleeding following major trauma: a European guideline.
Crit Care.
2007;
11
R17
-
13
Boffard K D, Riou B, Warren B et al.
Recombinant factor VII a as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials.
J Trauma.
2005;
59
8-15
-
14
Martinowitz U, Kenet G, Segal E et al.
Recombinant activated factor VII for adjunctive hemorrhage control in trauma.
J Trauma.
2001;
51
431-438
-
15
Vincent J L, Rossaint R, Riou B et al.
Recommendations on the use of recombinant activated factor VII as an adjunctive treatment for massive bleeding – a European perspective.
Crit Care.
2006;
10
R120
-
16
Powner D J, Hartwell E A, Hoots W K.
Counteracting the effects of anticoagulants and antiplatelet agents during neurosurgical emergencies.
Neurosurgery.
2005;
57
823-831
-
17
Raja S G, Shahbaz Y.
Desmopressin for haemostasis in cardiac surgery: when to use?.
Ann Card Anaesth.
2006;
9
102-107
-
18
Leithauser B, Zielske D, Seyfert U T et al.
Effects of desmopressin on platelet membrane glycoproteins and platelet aggregation in volunteers on clopidogrel.
Clin Hemorheol Microcirc.
2008;
39
293-302
-
19
Mahdy A M, Webster N R.
Perioperative systemic haemostatic agents.
Br J Anaesth.
2004;
93
842-858
-
20
Alanay A, Acaroglu E, Ozdemir O et al.
Effects of deamino-8-D-arginin vasopressin on blood loss and coagulation factors in scoliosis surgery. A double-blind randomized clinical trial.
Spine.
1999;
24
877-882
-
21
Flordal P A.
Use of desmopressin to prevent bleeding in surgery.
Eur J Surg.
1998;
164
5-11
-
22
Carless P A, Henry D A, Moxey A J et al.
Desmopressin for minimising perioperative allogeneic blood transfusion.
Cochrane Database Syst Rev.
2004;
CD001884
-
23
Treib J, Wenzel E.
Blutungskomplikationen durch Hydroxyethylstärke sind vermeidbar.
Dt Ärztebl.
1997;
94
2326-2330
-
24
Lison S, Innerhofer P, Spannagl M et al.
Interaction between volume therapy and coagulation.
NotfallRettungsmed.
2009;
12
176-180
-
25
Laupacis A, Fergusson D.
Drugs to minimize perioperative blood loss in cardiac surgery: meta-analyses using perioperative blood transfusion as the outcome. The International Study of Peri-operative Transfusion (ISPOT) Investigators.
Anesth Analg.
1997;
85
1258-1267
Dr. med. Peter Hilbert
Klinik für Anästhesiologie, Intensiv- und Notfallmedizin
BG-Kliniken Bergmannstrost
Merseburger Straße 165
06112 Halle
Phone: 03 45/1 32 63 43
Fax: 03 45/1 32 63 44
Email: dr.peterhilbert@web.de
