Kernaussagen
Das schwere Schädel-Hirn-Trauma ist in der Altersklasse unter 45 Jahren die häufigste Ursache für Mortalität und dauerhafte Morbidität. Ziel der Therapie ist es, sekundäre Hirnschäden so gering wie möglich zu halten und dadurch das neurologische Outcome zu verbessern. Eine der Hauptursachen für die Entwicklung sekundärer Hirnschäden ist die Hirnschwellung, durch die der intrakraniale Druck steigt und die zerebrale Sauerstoffversorgung verschlechtert wird. Daher muss auf optimale Oxygenierung und Perfusion geachtet werden.
Patienten mit schwerem Schädel-Hirn-Trauma sollen vom Notarzt in ein Traumazentrum mit neurochirurgischer Abteilung gebracht werden. Je nach dem Ergebnis einer sofort durchgeführten CT muss eine operative (Trepanation) oder primär konservative (Liquordrainage, Hyperventilation, Mannitol) Therapie eingeleitet werden. Dabei sollte man zur Überwachung den intrakranialen Druck und ggf. den Gewebesauerstoffgehalt (ptiO2), die zerebrale Durchblutung (CBF) und Gewebemetaboliten (Mikrodialyse) messen.
Durch das optimale Zusammenspiel von Notarzt, Schockraumteam und Intensivmedizinern kann die Überlebenschance und das neurologische Outcome von Patienten mit schwerem SHT oft entscheidend gebessert werden.
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Dr. med. Klaus Zweckberger
Neurochirurgische Klinik
Universität Heidelberg
Im Neuenheimer Feld 400
69120 Heidelberg
Phone: 06221/5636314
Email: klaus.zweckberger@med.uni-heidelberg.de
