Dartmouth Hitchcock Medical Center, Departments of Surgery, USA.
Curr Opin Anaesthesiol. 2010 Apr;23(2):246-50. doi: 10.1097/ACO.0b013e328336ea59.
Trauma patients requiring massive transfusion represent a population at high risk for potentially preventable death. This review describes recent advances in the early recognition and treatment of the coagulopathy of trauma, as well as ongoing work to define optimal resuscitation strategies.
Damage control resuscitation involves the rapid correction of hypothermia and acidosis, direct treatment of coagulopathy, and early transfusion in trauma patients. Recent evidence demonstrates improved mortality and lower overall blood product usage with higher ratios of plasma and platelets to red blood cells transfused. Adjuncts to damage control resuscitation such as factor VIIa may also be beneficial. Thrombelastography and advances in point-of-care testing may provide timely measurements to help guide massive transfusion in patients based on their individual needs.
As optimal resuscitation strategies continue to evolve, recent efforts have focused on early and aggressive treatment of coagulopathy, with higher ratios of plasma and platelets to red blood cells transfused. Early evidence suggests that such strategies have a beneficial outcome in regards to trauma-related mortality.
需要大量输血的创伤患者是一群面临潜在可预防死亡风险的高危人群。本篇综述描述了创伤性凝血病的早期识别和治疗方面的最新进展，以及正在进行的定义最佳复苏策略的工作。
损伤控制性复苏包括快速纠正低体温和酸中毒，直接治疗凝血病，并在创伤患者中早期输血。最近的证据表明，更高的血浆和血小板与红细胞输注比例可改善死亡率并降低总体血液制品的使用。损伤控制性复苏的辅助手段，如因子 VIIa，也可能有益。血栓弹力描记术和即时检测技术的进步可能会提供及时的测量结果，以根据患者的个体需求指导大量输血。
随着最佳复苏策略的不断发展，最近的努力重点在于早期和积极地治疗凝血病，增加血浆和血小板与红细胞的输注比例。早期证据表明，这些策略在创伤相关死亡率方面有有益的结果。
