Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, USA.
Curr Opin Crit Care. 2009 Dec;15(6):536-41. doi: 10.1097/MCC.0b013e328331575b.
Bleeding and death from hemorrhage remain a leading cause of morbidity and mortality in the trauma population. Early resuscitation of these gravely injured patients has changed significantly over the past several years. The concept of damage control resuscitation has expanded significantly with the experience of the US military in southwest Asia. This review will focus on this resuscitation strategy of transfusing blood products (red cells, plasma, and platelets) early and often in the exsanguinating patient.
In trauma there are no randomized controlled trials comparing the current damage control hematology concept to more traditional resuscitation methods. But the overwhelming conclusion of the data available support the administration of a high ratio of plasma and platelets to packed red blood cells. Several large retrospective studies have shown ratios close to 1: 1 will result in higher survival.
The current evidence supports that the acute coagulopathy of trauma is present in a high percentage of trauma patients. Patients who will require a massive transfusion will have improved outcomes the earlier that this is identified and the earlier that damage control hematology is instituted. Current evidence does not describe the best ratio but the preponderance of the data suggests it should be greater than 2: 3 plasma-to-packed red blood cells.
出血和出血导致的死亡仍然是创伤人群发病率和死亡率的主要原因。在过去的几年中，这些重伤患者的早期复苏发生了重大变化。随着美军在西南亚的经验，损伤控制性复苏的概念已经有了显著的扩展。这篇综述将重点关注这种在出血患者中早期和频繁输注血液制品（红细胞、血浆和血小板）的复苏策略。
在创伤中，没有随机对照试验将目前的损伤控制性血液学概念与更传统的复苏方法进行比较。但现有数据的压倒性结论支持给予高比例的血浆和血小板与浓缩红细胞。几项大型回顾性研究表明，接近 1:1 的比例将导致更高的生存率。
目前的证据支持创伤急性凝血病在很大比例的创伤患者中存在。需要大量输血的患者，如果能更早地发现这种情况，并更早地实施损伤控制性血液学治疗，其预后将会改善。目前的证据并没有描述最佳的比例，但大多数数据表明，它应该大于 2:3 的血浆与浓缩红细胞。
