Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany.
Intensive Care Med. 2011 Apr;37(4):572-82. doi: 10.1007/s00134-011-2139-y. Epub 2011 Feb 12.
The management of trauma patients suffering from active bleeding has improved with a better understanding of trauma-induced coagulopathy. The aim of this manuscript is to give recommendations for coagulation management.
A systematic literature search in the PubMed database was performed for articles published between January 2000 and August 2009. A total of 230 articles were included in the present systematic review.
The "coagulopathy of trauma" is a discrete disease which has a decisive influence on survival. Diagnosis and therapy of deranged coagulation should start immediately after admission to the emergency department. A specific protocol for massive transfusion should be introduced and continued. Loss of body temperature should be prevented and treated. Acidaemia should be prevented and treated by appropriate shock therapy. If massive transfusion is performed using fresh frozen plasma (FFP), a ratio of FFP to pRBC (packed red blood cells) of 1:2-1:1 should be achieved. Fibrinogen should be substituted at levels of <1.5 g/L. For patients suffering from active bleeding, permissive hypotension (i.e. mean arterial pressure ~65 mmHg) may be aimed for until surgical cessation of bleeding. This option is contraindicated in injuries of the central nervous system and in patients with coronary heart disease, or with known hypertension. Thrombelastography or -metry may be performed to guide coagulation diagnosis and substitution. Hypocalcaemia <0.9 mmol/L should be avoided and may be treated. For actively bleeding patients, pRBC may be given at haemoglobin <10 g/L (6.2 mmol/L) and haematocrit may be targeted at 30%.
随着对创伤后凝血功能障碍认识的提高，创伤患者伴活动性出血的处理得到了改善。本文旨在为凝血功能管理提供建议。
在 PubMed 数据库中进行了系统的文献检索，检索了 2000 年 1 月至 2009 年 8 月期间发表的文章。本系统评价共纳入 230 篇文章。
“创伤性凝血病”是一种明确的疾病，对存活率有决定性的影响。在急诊科入院后应立即开始诊断和治疗凝血功能障碍。应引入并持续进行大量输血的具体方案。应防止和治疗体温下降。应通过适当的休克治疗来防止和治疗酸中毒。如果使用新鲜冰冻血浆（FFP）进行大量输血，FFP 与红细胞（pRBC）的比例应为 1:2-1:1。纤维蛋白原应在 <1.5 g/L 时替代。对于活动性出血的患者，可在手术止血前允许低血压（即平均动脉压~65 mmHg）。该方案在中枢神经系统损伤、冠心病或已知高血压患者中禁忌。血栓弹性描记术或血栓弹性测定术可用于指导凝血诊断和替代。应避免血钙<0.9 mmol/L，并进行治疗。对于活动性出血的患者，在血红蛋白<10 g/L（6.2 mmol/L）时可给予红细胞，目标血细胞比容为 30%。
