Grassetto Alberto, Saggioro Debora, Caputo Paolo, Penzo Daniele, Bossi Antonio, Tedesco Massimo, Maggiolo Carlo
UOC Anestesia e Rianimazione, Dipartimento di Emergenza Urgenza, Ospedale dell'Angelo di Mestre, Venice, Italy.
Blood Coagul Fibrinolysis. 2012 Sep;23(6):551-5. doi: 10.1097/MBC.0b013e32835553c0.
Massive haemorrhage from facial fractures is rare but the associated mortality rate is high. Here, we describe a case in which thromboelastometry [rotational thromboelastometry (ROTEM)]-guided administration of prothrombin complex concentrate and fibrinogen concentrate was effective in correcting coagulopathy in a 68-year-old man with serious craniofacial trauma and massive haemorrhage. The patient, a cyclist who collided with a car, was transferred to the emergency department of our hospital with signs of shock and significant bleeding from multiple fractures and soft tissue injuries to the face. Blood gas analysis and standard laboratory tests revealed the presence of anaemia and acidosis, and our massive haemorrhage protocol was initiated. E-FAST and total-body computed tomography scans excluded the possibility of bleeding from other sites. All efforts were directed towards stopping bleeding from craniofacial lesions, but the surgeon experienced difficulty in maintaining haemostasis. ROTEM analysis revealed severe coagulopathy and was indispensable in guiding transfusion: 2 g tranexamic acid, followed by 1000 IU prothrombin complex concentrate, 5 g fibrinogen and 2 U platelet concentrate. Two hours later, ROTEM analysis showed that coagulopathy had been corrected, and haemostasis was confirmed by cessation of bleeding. This report highlights the potential for using ROTEM to guide treatment with fibrinogen and prothrombin complex concentrates in the presence of profuse multifocal bleeding and severe coagulopathy.
面部骨折导致的大出血较为罕见，但相关死亡率很高。在此，我们描述了一例病例，在一名患有严重颅面创伤和大出血的68岁男性患者中，血栓弹力图[旋转血栓弹力图（ROTEM）]引导下给予凝血酶原复合物浓缩剂和纤维蛋白原浓缩剂有效地纠正了凝血功能障碍。该患者是一名骑自行车者，与一辆汽车相撞，因休克体征以及面部多处骨折和软组织损伤导致大量出血被转运至我院急诊科。血气分析和标准实验室检查显示存在贫血和酸中毒，我们启动了大出血治疗方案。超声重点评估（E-FAST）和全身计算机断层扫描排除了其他部位出血的可能性。所有努力都旨在止住颅面损伤的出血，但外科医生在维持止血方面遇到困难。ROTEM分析显示存在严重凝血功能障碍，在指导输血方面不可或缺：先给予2 g氨甲环酸，随后给予1000 IU凝血酶原复合物浓缩剂、5 g纤维蛋白原和2 U血小板浓缩剂。两小时后，ROTEM分析显示凝血功能障碍已得到纠正，出血停止证实了止血效果。本报告强调了在存在大量多灶性出血和严重凝血功能障碍的情况下，使用ROTEM指导纤维蛋白原和凝血酶原复合物浓缩剂治疗的潜力。
