Gentilello L M, Pierson D J
Departments of Surgery and Medicine, and Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, and University of Washington, Seattle, Washington 98104, USA.
Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):604-7. doi: 10.1164/ajrccm.163.3.2004106.
The surgical approach to the most injured patients has changed in recent years. Many patients arrive in the intensive care unit with problems that in the past would have been definitively addressed in the operating room, or led to the patient's demise due to continued attempts to complete all surgical procedures, despite deteriorating physiology. As a result, the triad of hypothermia, acidosis, and coagulopathy, along with the frequent complication of abdominal compartment syndrome, are critical factors that require correction in the intensive care unit. Prompt correction is necessary not only to allow expeditious completion of required surgical procedures, but because this triad, unless interrupted, invariably leads to death during resuscitation.
近年来,针对伤势最严重患者的手术方式发生了变化。许多患者被送入重症监护病房时存在的问题,在过去本应在手术室得到彻底解决,或者由于尽管生理状况不断恶化仍继续尝试完成所有外科手术,最终导致患者死亡。因此,体温过低、酸中毒和凝血功能障碍这三者,以及腹部间隔综合征的常见并发症,都是重症监护病房中需要纠正的关键因素。迅速纠正不仅是为了能迅速完成所需的外科手术,还因为除非中断这三者的恶性循环,否则在复苏过程中患者必然会死亡。