Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
Scand J Trauma Resusc Emerg Med. 2012 Jul 9;20:47. doi: 10.1186/1757-7241-20-47.
Hemorrhage remains a major cause of potentially preventable deaths. Trauma and massive transfusion are associated with coagulopathy secondary to tissue injury, hypoperfusion, dilution, and consumption of clotting factors and platelets. Concepts of damage control surgery have evolved prioritizing early control of the cause of bleeding by non-definitive means, while hemostatic control resuscitation seeks early control of coagulopathy.Hemostatic resuscitation provides transfusions with plasma and platelets in addition to red blood cells in an immediate and sustained manner as part of the transfusion protocol for massively bleeding patients. Although early and effective reversal of coagulopathy is documented, the most effective means of preventing coagulopathy of massive transfusion remains debated and randomized controlled studies are lacking. Viscoelastical whole blood assays, like TEG and ROTEM however appear advantageous for identifying coagulopathy in patients with severe hemorrhage as opposed the conventional coagulation assays.In our view, patients with uncontrolled bleeding, regardless of it's cause, should be treated with hemostatic control resuscitation involving early administration of plasma and platelets and earliest possible goal-directed, based on the results of TEG/ROTEM analysis. The aim of the goal-directed therapy should be to maintain a normal hemostatic competence until surgical hemostasis is achieved, as this appears to be associated with reduced mortality.
出血仍然是潜在可预防死亡的主要原因。创伤和大量输血与组织损伤、低灌注、稀释以及凝血因子和血小板消耗引起的凝血功能障碍有关。损伤控制手术的概念已经发展，优先通过非确定性手段早期控制出血原因，同时止血控制复苏旨在早期控制凝血功能障碍。作为大量出血患者输血方案的一部分，止血复苏以立即和持续的方式提供除红细胞以外的血浆和血小板输血。尽管早期和有效的凝血功能障碍逆转得到了证实，但预防大量输血凝血功能障碍的最有效方法仍存在争议，并且缺乏随机对照研究。然而，与传统凝血检测相比，粘弹性全血检测（如 TEG 和 ROTEM）似乎更有利于识别严重出血患者的凝血功能障碍。在我们看来，无论出血原因如何，对于无法控制出血的患者，应采用止血控制复苏治疗，包括早期给予血浆和血小板输血，并根据 TEG/ROTEM 分析的结果尽早进行目标导向治疗。目标导向治疗的目的应该是维持正常的止血能力，直到实现手术止血，因为这似乎与降低死亡率有关。
