Meier Jens, Habler Oliver
Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie des Klinikums der Johann-Wolfgang-Goethe-Universität in Frankfurt am Main.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2007 Oct;42(10):724-30. doi: 10.1055/s-2007-993022.
Patients admitted to an intensive care unit with the diagnosis "polytrauma" differ from other patients by their typical trauma-associated morbidity (diffusive bleeding, traumatic brain injury, lung contusion), and by the staged surgical treatment of multiple injuries. The complexity of the clinical picture, and the complexity of the chronological order of the operative phases require a close cooperation of the medical specialist disciplines involved. The perioperative morbidity and mortality of polytrauma victims has been reduced significantly within the last 30 years due to an adapted transfusion- and substitution regime (rational utilization of anemia tolerance, calculated substitution of coagulation factors), due to modern therapeutic regimes for the patient with traumatic brain injury (stabilization of cerebral perfusion pressure, stabilization of adequate cerebral oxygenation), and due to the modern therapeutic strategies of mechanical ventilation (lung-protective ventilation, kinetic therapy, non-invasive ventilation). The aim of this review is to describe these modern therapeutic principles of the intensive care unit treatment of the polytrauma patient.
因“多发伤”诊断而入住重症监护病房的患者,与其他患者的不同之处在于其典型的创伤相关发病率(弥漫性出血、创伤性脑损伤、肺挫伤),以及对多处损伤的分期手术治疗。临床表现的复杂性以及手术阶段时间顺序的复杂性,需要相关医学专科密切合作。在过去30年中,由于采用了适应性输血和替代方案(合理利用贫血耐受性、计算凝血因子替代量)、针对创伤性脑损伤患者的现代治疗方案(稳定脑灌注压、稳定充足的脑氧合)以及机械通气的现代治疗策略(肺保护性通气、动态治疗、无创通气),多发伤患者的围手术期发病率和死亡率已显著降低。本综述的目的是描述多发伤患者重症监护病房治疗的这些现代治疗原则。