St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside L35 5DR, UK.
Emerg Med J. 2013 Jan;30(1):9-14. doi: 10.1136/emermed-2011-201061. Epub 2012 Feb 10.
Inadequate resuscitation of major haemorrhage is an important cause of avoidable death in severely injured patients. Early recognition of blood loss, control of bleeding and restoration of circulating volume are critical to the management of trauma shock, and transfusion of blood components is a key intervention. Vital signs may be inadequate to determine the need for transfusion, and resuscitation regimens targeting vital signs may be harmful in the context of uncontrolled bleeding. This article addresses current concepts in haemostatic resuscitation. Recent guidelines on the diagnosis and treatment of coagulopathy in major trauma, and the role of component and adjuvant therapies, are considered. Finally, the potential role of thromboelastography and rotational thromboelastometry are discussed.
大出血时复苏不充分是严重创伤患者可避免死亡的一个重要原因。早期识别失血、控制出血和恢复循环血量对创伤性休克的治疗至关重要，输血是关键干预措施。生命体征可能不足以确定输血的必要性，而针对生命体征的复苏方案在无法控制出血的情况下可能有害。本文介绍了当前的止血复苏概念。本文还考虑了最近关于严重创伤中凝血障碍的诊断和治疗指南，以及成分治疗和辅助治疗的作用。最后，还讨论了血栓弹力描记术和旋转血栓弹力描记术的潜在作用。
