{"id":4192,"date":"2023-04-05T08:19:59","date_gmt":"2023-04-05T06:19:59","guid":{"rendered":"http:\/\/berlin-boehm.de\/Kanty\/?p=4192"},"modified":"2023-04-05T08:20:01","modified_gmt":"2023-04-05T06:20:01","slug":"schwere-blutung","status":"publish","type":"post","link":"http:\/\/berlin-boehm.de\/Kanty\/archive\/4192","title":{"rendered":"Schwere Blutung"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_one_full-7acc1372e522d1472d3487e02738ae1c\">\n.flex_column.av-av_one_full-7acc1372e522d1472d3487e02738ae1c{\nbackground-color:#22689e;\n}\n<\/style>\n<div  class='flex_column av-av_one_full-7acc1372e522d1472d3487e02738ae1c av_one_full  avia-builder-el-0  el_before_av_hr  avia-builder-el-first  first flex_column_div  '     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-lg3aulxw-4e386891228c2c6050cc8561ff1b09b6\">\n#top .av-special-heading.av-lg3aulxw-4e386891228c2c6050cc8561ff1b09b6{\nmargin:20px 20px 20px 20px;\npadding-bottom:0;\ncolor:#ffffff;\n}\nbody .av-special-heading.av-lg3aulxw-4e386891228c2c6050cc8561ff1b09b6 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-lg3aulxw-4e386891228c2c6050cc8561ff1b09b6 .av-special-heading-tag{\npadding:5px 5px 5px 5px;\n}\n.av-special-heading.av-lg3aulxw-4e386891228c2c6050cc8561ff1b09b6 .special-heading-inner-border{\nborder-color:#ffffff;\n}\n.av-special-heading.av-lg3aulxw-4e386891228c2c6050cc8561ff1b09b6 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-lg3aulxw-4e386891228c2c6050cc8561ff1b09b6 av-special-heading-h3 custom-color-heading blockquote classic-quote  avia-builder-el-1  avia-builder-el-no-sibling '><h3 class='av-special-heading-tag '  itemprop=\"headline\"  >Schwere Blutung<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div><div  class='hr av-av_hr-91d7ccd583a503147498e120fee2ff9b hr-default  avia-builder-el-2  el_after_av_one_full  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><\/p>\n<section  class='av_textblock_section av-lg3autqj-10937da6b737a1474b9555ad45057beb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p>Bei schweren Blutungen oder der Gefahr der schweren Blutung sollten Chirurgen geeignete Ma\u00dfnahmen ergreifen, das Blutungsgeschehen zu kontrollieren und ein R\u00fcckfall zu vermeiden. Dabei sollte sich der Operateur prim\u00e4r auf eine intakte Gerinnung konzentrieren.<\/p>\n<h4>Intakte Gerinnung<\/h4>\n<p>Eine Hypothermie sollte unbedingt vermieden werden. Bereits eine Temperatur unter 35 \u00b0C ist gef\u00e4hrlich, denn die plasmatische Gerinnungsaktivit\u00e4t sinkt um 10 Prozent pro 1\u00b0C. Bei einer Temperatur unter 34\u00b0C tritt eine Thrombozytopenie ein, weil sich die Thrombozyten in der Milz sammeln.<\/p>\n<p>Bei einem gest\u00f6rten Metabolismus tritt rasch eine Azidose auf, die ebenfalls die Gerinnung verschlechtert, weil die Proteasen ihr Aktivit\u00e4tsoptimum im alkalischen Bereich aufweisen. Deshalb sollte eine Azidose gemieden oder rasch ausgeglichen werden.<\/p>\n<p>Auch eine An\u00e4mie verl\u00e4ngert nachweislich die Blutungszeit. In kritischen Situationen ist ein Hb von 9 g\/dl sicherlich ein gutter Triggerpunkt.<\/p>\n<h4>\u00dcbersteigerte Fibrinolyse<\/h4>\n<p>An eine gesteigerte Fibrinolyse sollte ebenfalls gedacht werden. Zur Behandlung bietet sich hier die Tranexams\u00e4ure an, die das Plasminogen blockiert. Der Wirkunsgeintritt ist verz\u00f6gert, weil es nicht auf aktiviertes Plasmin wirkt.<\/p>\n<h4>Fibrinogen und Thrombozyten<\/h4>\n<p>Da Fibrin in der akuten Situation rasch verbraucht werden kann, sollte es gemessen und substituiert werden, wenn es unter 1,5 g\/l betr\u00e4gt. Die Thrombozyten sollten ebenfalls kontrolliert und im Zweifel substituiert werden, wenn weniger als 50.000 funktiont\u00fcchtiger Thrombozyten nachweisbar sind.<\/p>\n<h4>EK und FFP<\/h4>\n<p>Bei schweren akuten Blutungen werden von einigen Chirurgen ein festes Verh\u00e4ltnis von Ek- und FFP-Gaben empfohlen. Einige geben es im Verh\u00e4ltnis von 1:1-1:0,5. Die feste Gabe von FFP soll zu weniger schweren Blutungen f\u00fchren.<\/p>\n<\/div><\/section>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_themeisle_gutenberg_block_has_review":false,"footnotes":""},"categories":[34],"tags":[],"class_list":["post-4192","post","type-post","status-publish","format-standard","hentry","category-chirurgie"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Schwere Blutung - Berliner Gelassenheit<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/berlin-boehm.de\/Kanty\/archive\/4192\" \/>\n<meta property=\"og:locale\" content=\"de_DE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Schwere Blutung - Berliner Gelassenheit\" \/>\n<meta property=\"og:url\" content=\"http:\/\/berlin-boehm.de\/Kanty\/archive\/4192\" \/>\n<meta property=\"og:site_name\" content=\"Berliner Gelassenheit\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-05T06:19:59+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-05T06:20:01+00:00\" \/>\n<meta name=\"author\" content=\"Bartholom\u00e4us B\u00f6hm\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Verfasst von\" \/>\n\t<meta name=\"twitter:data1\" content=\"Bartholom\u00e4us B\u00f6hm\" \/>\n\t<meta name=\"twitter:label2\" content=\"Gesch\u00e4tzte Lesezeit\" \/>\n\t<meta name=\"twitter:data2\" content=\"3\u00a0Minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/archive\\\/4192#article\",\"isPartOf\":{\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/archive\\\/4192\"},\"author\":{\"name\":\"Bartholom\u00e4us B\u00f6hm\",\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/#\\\/schema\\\/person\\\/e7bb56a842d02bb40f4663709bf5242d\"},\"headline\":\"Schwere Blutung\",\"datePublished\":\"2023-04-05T06:19:59+00:00\",\"dateModified\":\"2023-04-05T06:20:01+00:00\",\"mainEntityOfPage\":{\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/archive\\\/4192\"},\"wordCount\":743,\"publisher\":{\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/#\\\/schema\\\/person\\\/e7bb56a842d02bb40f4663709bf5242d\"},\"articleSection\":[\"Chirurgie\"],\"inLanguage\":\"de\"},{\"@type\":\"WebPage\",\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/archive\\\/4192\",\"url\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/archive\\\/4192\",\"name\":\"Schwere Blutung - Berliner Gelassenheit\",\"isPartOf\":{\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/#website\"},\"datePublished\":\"2023-04-05T06:19:59+00:00\",\"dateModified\":\"2023-04-05T06:20:01+00:00\",\"breadcrumb\":{\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/archive\\\/4192#breadcrumb\"},\"inLanguage\":\"de\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/archive\\\/4192\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/archive\\\/4192#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Startseite\",\"item\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Schwere Blutung\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/#website\",\"url\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/\",\"name\":\"Berliner Gelassenheit\",\"description\":\"Heiterkeit und Widerspr\u00fcche\",\"publisher\":{\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/#\\\/schema\\\/person\\\/e7bb56a842d02bb40f4663709bf5242d\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"de\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/#\\\/schema\\\/person\\\/e7bb56a842d02bb40f4663709bf5242d\",\"name\":\"Bartholom\u00e4us B\u00f6hm\",\"logo\":{\"@id\":\"http:\\\/\\\/berlin-boehm.de\\\/Kanty\\\/#\\\/schema\\\/person\\\/image\\\/\"},\"description\":\"Prof. Dr. med. 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