Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre, Salzburg, Austria.
J Cardiothorac Vasc Anesth. 2013 Aug;27(4 Suppl):S35-43. doi: 10.1053/j.jvca.2013.05.015.
Hemorrhage remains one of the leading causes of trauma-related deaths. Uncontrolled diffuse microvascular bleeding in the course of initial care is common, potentially resulting in exsanguination. Early and aggressive hemostatic intervention increases survival and reduces the incidence of massive transfusion. Thus, timely diagnosis of the underlying coagulation disorders is mandatory. It has been shown that standard coagulation tests do not sufficiently characterize trauma-induced coagulopathy (TIC). This has led to increasing interest in alternatives, such as the viscoelastic test, to diagnose TIC and to provide the basis for a goal-directed hemostatic therapy. The concept of damage control resuscitation (DCR) has been introduced widely in trauma patients with severe bleeding. This strategy addresses important confounders of the coagulation process such as hemodilution, hypothermia, and acidosis; DCR is based on a damage control surgical approach, permissive hypotension, and improvement of hemostatic competence. Many studies have shown benefit in mortality when using high ratios of fresh frozen plasma (FFP) to red blood cells (RBC) as early treatment. However, there is increased awareness that coagulation factor concentrate could be beneficial in the treatment of trauma-induced coagulopathy.
出血仍然是创伤相关死亡的主要原因之一。在初步治疗过程中，弥漫性微血管不可控制的出血很常见，可能导致出血性休克。早期和积极的止血干预可提高存活率并降低大量输血的发生率。因此，及时诊断潜在的凝血障碍是强制性的。事实证明，标准凝血试验不能充分描述创伤引起的凝血障碍（TIC）。这导致人们越来越关注替代方法，例如粘弹性测试，以诊断 TIC 并为有针对性的止血治疗提供基础。损伤控制性复苏（DCR）的概念已在严重出血的创伤患者中广泛引入。该策略解决了凝血过程中的重要混杂因素，如血液稀释、低体温和酸中毒；DCR 基于损伤控制性手术方法、允许性低血压和止血能力的改善。许多研究表明，使用高比例的新鲜冷冻血浆（FFP）与红细胞（RBC）作为早期治疗可降低死亡率。然而，人们越来越意识到凝血因子浓缩物在治疗创伤引起的凝血障碍方面可能有益。
