de Guzman E, Shankar M N, Mattox K L
Trauma Services, Ben Taub General Hospital, Houston, TX 77030, USA.
AACN Clin Issues. 1999 Feb;10(1):61-8.
Trauma is the leading cause of death in young adults. Development of trauma centers in urban settings including emergency medical services has contributed greatly to the improved quality of trauma patient care. Based on animal experiments performed 3 decades ago, the traditional management of hypovolemic hemorrhagic shock includes adequate circulatory volume with aggressive initial infusion of crystalloid solution. However, in several recent animal studies, investigators have found that aggressive treatment with fluids before control of bleeding results in a higher mortality rate, especially if blood pressure is elevated. This notion has been supported by findings in a recent prospective, randomized study involving patients with penetrating injuries to the torso. This article discusses briefly the pathophysiology of shock and hemostasis and the current literature on fluid resuscitation, with emphasis on limited volume resuscitation in patients with penetrating thoracoabdominal injuries.
创伤是青壮年人群的首要死因。在城市地区建立包括紧急医疗服务在内的创伤中心，对提高创伤患者的护理质量起到了极大的推动作用。基于30年前进行的动物实验，传统的低血容量性失血性休克治疗方法包括通过积极初始输注晶体溶液来维持足够的循环血量。然而，近期的多项动物研究发现，在控制出血之前积极进行液体治疗会导致更高的死亡率，尤其是在血压升高的情况下。这一观点得到了最近一项针对躯干穿透伤患者的前瞻性随机研究结果的支持。本文简要讨论休克和止血的病理生理学以及当前关于液体复苏的文献，重点关注胸腹穿透伤患者的限制性液体复苏。
