Therapie postoperativer Darmpassagestörungen in der Intensivmedizin

Der postoperative Ileus (POI) ist eine physiologische Reaktion des Magen-Darm-Traktes, welche vor allem nach offenen abdominal-chirurgischen Eingriffen beobachtet wird. Das häufige Krankheitsbild belastet nicht nur den individuellen Patienten, sondern auch das Gesundheitssystem über längere Krankenhausverweildauer und konsekutiv höhere Behandlungskosten. Der vorliegende Artikel fasst die aktuelle Datenlage zur Therapie des POI zusammen.

Kernaussagen

• Beim postoperativen Ileus handelt es sich um eine häufige physiologische bis pathologische Paralyse des Magen-Darm-Traktes mit sowohl subjektiver Belastung des einzelnen Patienten als auch objektiver Belastung des Gesundheitssystems.

• Das multifaktoriell bedingte Krankheitsbild sollte vor allem durch eine suffiziente Prävention abgewendet werden.

• Präoperativ zählen zu den beeinflussbaren Faktoren der Prävention ein ausgeglichener Wasser- und Elektrolythaushalt, die kurze präoperative Nahrungskarenz, ggf. mit Carbohydrate Loading.

• Intraoperativ sollten eine Epiduralanalgesie eingesetzt und die Opioiddosis so gering wie möglich gehalten werden. Außerdem sollten minimalinvasive Operationstechniken mit geringer Manipulation am Darm bevorzugt werden.

• Postoperativ sollte eine Nasensonde zeitnah entfernt, der Patient ab dem 1. Tag mobilisiert werden und ab demselben Tag mit der oralen Nahrungsaufnahme beginnen.

• Tritt trotz alledem ein POI auf, sind die typischen Symptome ein aufgetriebenes, schmerzhaftes Abdomen, die Intoleranz gegenüber oraler Nahrungsaufnahme, fehlende Winde und fehlender Stuhlabgang sowie Übelkeit und Erbrechen.

• Das Krankheitsbild wird klinisch diagnostiziert.

• Bei Auftreten eines POI werden die Gabe von Alvimopan per os und das Kauen von Kaugummi empfohlen.

• Weitere mögliche Therapieansätze umfassen die Gabe von Kaffee, die Behandlung mit NSAID, Gastrografin, Magnesium i. v., Daikenchuto, Mosapride, Laxanzien, Nikotin und Erythromycin.

Schlüsselwörter

postoperativer Ileus (POI) - Magen-Darm-Trakt - Darmverschluss - Motilitätsstörungen des Darms

• Literatur

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