Department of Anesthesiology, University of Maryland, R Adams Cowley Shock Trauma Center, 22 South Greene St., T1R77, Baltimore, MD 21201, USA.
Anesth Analg. 2012 Dec;115(6):1326-33. doi: 10.1213/ANE.0b013e3182639f20. Epub 2012 Jul 4.
The management of trauma patients has matured significantly since a systematic approach to trauma care was introduced nearly a half century ago. The resuscitation continuum emphasizes the effect that initial therapy has on the outcome of the trauma patient. The initiation of this continuum begins with prompt field medical care and efficient transportation to designated trauma centers, where lifesaving procedures are immediately undertaken. Resuscitation with packed red blood cells and plasma, in parallel with surgical or interventional radiologic source control of bleeding, are the cornerstones of trauma management. Adjunctive pharmacologic therapy can assist with resuscitation. Tranexamic acid is used in Europe with good results, but the drug is slowly being added to the pharmacy formulary of trauma centers in United States. Recombinant factor VIIa can correct abnormal coagulation values, but its outcome benefit is less clear. Vasopressin shows promise in animal studies and case reports, but has not been subjected to a large clinical trial. The concept of "early goal-directed therapy" used in sepsis may be applicable in trauma as well. An early, appropriately aggressive resuscitation with blood products, as well as adjunctive pharmacologic therapy, may attenuate the systemic inflammatory response of trauma. Future investigations will need to determine whether this approach offers a similar survival benefit.
自近半个世纪前引入创伤患者的系统治疗方法以来，创伤患者的管理已经显著成熟。复苏连续体强调了初始治疗对创伤患者结局的影响。该连续体的启动始于迅速的现场医疗和高效的转运至指定的创伤中心，在那里立即进行救生程序。与手术或介入放射源控制出血并行的红细胞和血浆的复苏，是创伤管理的基石。辅助药物治疗可以协助复苏。氨甲环酸在欧洲使用效果良好，但该药在美国创伤中心的药房处方中添加速度较慢。重组 VII 因子可以纠正异常的凝血值，但它的结果益处不太明确。加压素在动物研究和病例报告中显示出前景，但尚未进行大规模临床试验。在败血症中使用的“早期目标导向治疗”概念在创伤中也可能适用。早期、适当积极的血液制品复苏以及辅助药物治疗，可能减轻创伤的全身炎症反应。未来的研究需要确定这种方法是否提供类似的生存获益。
