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Hamostaseologie 1993; 13(02): 80-89
DOI: 10.1055/s-0038-1655216
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Schattauer GmbH

Vasodilatative Prostanoide und pulmonale Strombahn

D Walmrath
1Medizinische Klinik I des Zentrums für Innere Medizin der Justus-Liebig-Universität Gießen (Direktor: Prof. Dr. Dr. h. c. mult. H.-G. Lasch)
,
W Seeger
1Medizinische Klinik I des Zentrums für Innere Medizin der Justus-Liebig-Universität Gießen (Direktor: Prof. Dr. Dr. h. c. mult. H.-G. Lasch)
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Publication History

Publication Date:
26 June 2018 (online)

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Zusammenfassung

Die Prostanoide PGE1 und PGl2 besitzen eine ausgeprägte vasodilatative Potenz in der pulmonalen Zirkulation. Sie sind prinzipiell in der Lage, vasokonstriktive Stimuli mit präund/oder postkapillärer Lokalisation zu antagonisieren. Sie sind nach intravenöser Applikation jedoch nicht pulmonal selektiv, sondern biologisch wirksame Mengen gelangen auch in die systemische Zirkulation mit resultierender Abnahme des gesamtperipheren Widerstandes. Intravenös zugeführte vasodilatative Prostanoide besitzen zudem keine intrapulmonale Selektivität. Aufgrund ihres Wirkungsprofils und ihrer guten Titrierbarkeit stellen vasodilatative Prostanoide im intensivmedizinischen Bereich dennoch für ausgesuchte Patienten mit kritischer pulmonaler Hypertension und Rechtsherz-Dekompensation ein wertvolles therapeutisches Agens dar. Bei rechtskardialer Dekompensation im Rahmen der primären pulmonalen Hypertonie kann eine ambulante intravenöse Dauerinfusion von PGE1 oder PGI2 praktiziert werden, um eine Überbrückung zur (Herz-)Lungentransplantation zu erreichen. Bei Patienten mit ARDS und Sepsis sind vasodilatative Prostanoide mit dem Ziel eingesetzt worden, über eine Steigerung des Sauerstofftransportes und eine Beeinflussung mikrozirkulatorischer Verteilungsstörungen eine Steigerung der Sauerstoffaufnahme und somit der Reduktion der Organkomplikationen zu erreichen. Perspektivisch könnte eine Aerosolapplikation vasodilatativer Prostanoide hilfreich sein, eine pulmonale und intrapulmonale Selektivität der Vasodilatation durch diese Agenzien zu erzielen.

Schlüsselwörter

Vasodilatative Prostanoide - Prostaglandin E1 und l2 pulmonale Hypertonie - akutes respiratorisches Distress Syndrom (ARDS) - Sepsis
 

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