Parreira José Gustavo, Soldá Silvia, Rasslan Samir
Serviço de Emergência do Departamento de Cirurgia, Faculdade de Ciências Mêdicas, Santa Casa de São Paulo, Brasil.
Arq Gastroenterol. 2002 Jul-Sep;39(3):188-97. doi: 10.1590/s0004-28032002000300010. Epub 2003 May 21.
Despite the advances in the treatment of exanguinating patients, hemorrhage remains as the leading cause of early deaths. A great deal of attention has been given to "damage control" as a therapeutic alternative in this scenario.
To appraise the definition, indications, operative techniques and results of damage control for the treatment of exanguinating trauma patients.
Bibliographic review.
Damage control introduces the concept of breaking the vicious cycle of metabolic acidosis, hypothermia and coagulopathy which results from hemorrhagic shock. Thus, the operation has to be interrupted before this irreversible stage, even if the injured organs were not given the definitive treatment at this moment. So, damage control involves three steps: an abbreviated operation, a recovering period in the intensive care unit, and the reoperation for the definitive treatment. At the abbreviated operation, operative techniques as stapling intestinal injuries or packing liver wounds are applied, allowing rapid control of the bleeding and spillage. In the intensive care unit, the patient is warmed, oxygen delivery and consumption are restored and coagulation factors administered. As soon as the hemodynamic stability, ideal body temperature and coagulation status are reached, the definitive operation is carried out. Damage control is a helpful option if correctly used. However, there are also severe complications that can occur. Therefore, it should be employed only in centers that could provide optimum resources.
Damage control is an important tactical alternative for the treatment of exanguinating trauma patients.
尽管在治疗大出血患者方面取得了进展，但出血仍然是早期死亡的主要原因。在这种情况下，“损伤控制”作为一种治疗选择受到了广泛关注。
评估损伤控制在治疗大出血创伤患者中的定义、适应证、手术技术及效果。
文献综述。
损伤控制引入了打破失血性休克所致代谢性酸中毒、体温过低和凝血功能障碍恶性循环的概念。因此，即使受伤器官此时未得到确定性治疗，手术也必须在这个不可逆阶段之前中断。所以，损伤控制包括三个步骤：简化手术、在重症监护病房的恢复期以及进行确定性治疗的再次手术。在简化手术中，应用如缝合肠损伤或填塞肝伤口等手术技术，以便快速控制出血和防止渗漏。在重症监护病房，患者要进行保暖、恢复氧输送和消耗，并给予凝血因子。一旦达到血流动力学稳定、理想体温和凝血状态，就进行确定性手术。如果正确使用，损伤控制是一种有益的选择。然而，也可能会出现严重并发症。因此，它应仅在能够提供最佳资源的中心使用。
损伤控制是治疗大出血创伤患者的一种重要策略选择。
