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Intensivmedizin up2date 2012; 8(1): 49-65
DOI: 10.1055/s-0030-1257123
Internistische Intensivmedizin

© Georg Thieme Verlag KG Stuttgart · New York

Therapie der akuten Pankreatitis

Julia  Mayerle, Peter  Simon, Markus  M.  Lerch
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Publication Date:
12 January 2012 (online)

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Bei der unkomplizierten ödematös-interstitiellen Pankreatitis liegt die Mortalität unter 1 %, bei der hämorrhagisch-nekrotisierende Pankreatitis dagegen bei 10 – 24 %. Frühe prognostische Faktoren zur Beurteilung des klinischen Verlaufs sind 3 oder mehr Hinweise auf Organkomplikationen oder der Nachweis von Pankreasnekrosen im kontrastmittelverstärkten CT. Auch ein bis auf 130 mg/l erhöhter CRP-Wert kann frühzeitig auf einen komplizierten Verlauf hinweisen.

Die entscheidende therapeutische Maßnahme bei der Behandlung der akuten Pankreatitis ist die ausreichende Substitution des Flüssigkeitsverlusts. Außerdem muss eine suffiziente analgetische Therapie oberstes Ziel der Behandlung sein. Eine antibiotische Therapie sollte Patienten mit infizierter Nekrose vorbehalten bleiben und nicht als grundsätzliche Prophylaxe eingesetzt werden. Eine enterale Ernährung bei Patienten mit akuter Pankreatitis ist der parenteralen Ernährung überlegen, kann sie aber nicht immer vollständig ersetzen.

Die minimal invasiven Therapieverfahren sind der offenen Operation bei infizierter Nekrose überlegen. Bei biliärer Pankreatitis ist eine endoskopische Papillotomie während des ersten stationären Aufenthalts notwendig. Innerhalb von 6 Wochen nach der Klinikentlassung sollte man dann eine Cholezystektomie durchführen.

    Die Literatur zu diesem Beitrag finden Sie unter http://dx.doi.org/10.1055/s-0030-1257123.
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Prof. Dr. Markus M. Lerch

Klinik und Poliklinik für Innere Medizin A
Ernst-Moritz-Arndt Universität Greifswald

Friedrich-Loeffler-Str. 23A
17475 Greifswald

Phone: 03834/867230

Fax: 03834/867234

Email: lerch@uni-greifswald.de

      Die Literatur zu diesem Beitrag finden Sie unter http://dx.doi.org/10.1055/s-0030-1257123.
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