Trauma Sciences, Blizard Institute, Bart's and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
Br J Haematol. 2011 Dec;155(5):537-48. doi: 10.1111/j.1365-2141.2011.08885.x. Epub 2011 Oct 21.
The severely injured trauma patient often arrives in the emergency department bleeding, coagulopathic and in need of a blood transfusion. The diagnosis and management of these patients has vastly improved with a better understanding of acute traumatic coagulopathy (ATC). In the emergency setting, traditional laboratory coagulation screens are of limited use in the diagnosis and management of life-threatening bleeding. Whole blood assays, such as thrombelastography (TEG) and rotational thrombelastometry (ROTEM) provide a rapid evaluation of clot formation, strength and lysis. Rapid diagnosis of ATC and aggressive haemostatic transfusion strategies utilizing early high doses of plasma are associated with improved outcomes in trauma. At present there is no accurate guide for transfusion in trauma, therefore blood and clotting products are administered on an empiric basis. Targeted transfusion therapy for major trauma haemorrhage based on comprehensive and rapid measures of coagulation e.g. TEG/ROTEM may lead to improved outcomes while optimizing blood utilization. Evidence for the clinical application of TEG and ROTEM in trauma is emerging with a number of studies evaluating their ability to diagnose coagulopathy early and facilitate goal-directed transfusion. This review explores current controversies and best practice in the diagnosis and management of major haemorrhage in trauma.
严重创伤患者常因出血、凝血功能障碍而在急诊科就诊，需要输血。由于对急性创伤性凝血病（ATC）有了更好的认识，这些患者的诊断和治疗得到了极大的改善。在急诊环境中，传统的实验室凝血筛查在诊断和治疗危及生命的出血方面作用有限。全血检测，如血栓弹力图（TEG）和旋转血栓弹力图（ROTEM），可快速评估凝血形成、强度和溶解情况。快速诊断 ATC 和使用早期高剂量血浆进行积极止血输血策略与改善创伤结局相关。目前，创伤患者输血没有准确的指南，因此血液和凝血产品是根据经验进行输注的。基于全面和快速的凝血检测，例如 TEG/ROTEM，对大出血进行靶向输血治疗可能会改善结局并优化血液利用。TEG 和 ROTEM 在创伤中的临床应用证据不断涌现，许多研究评估了它们早期诊断凝血功能障碍和促进目标导向输血的能力。这篇综述探讨了创伤中大出血的诊断和管理方面的当前争议和最佳实践。
