Godier A, Susen S
Service d'anesthésie-réanimation chirurgicale, université Paris-Descartes, hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Ann Fr Anesth Reanim. 2013 Jul-Aug;32(7-8):527-30. doi: 10.1016/j.annfar.2013.07.013. Epub 2013 Jul 31.
Hemorrhage is the leading cause of death in trauma patients who arrive alive at hospital. This type of hemorrhage has a "coagulopathic" component, specific to major trauma and associated with poor outcomes. Over the last decade, a better understanding of this trauma-induced coagulopathy lead to a new therapeutic approach requiring earlier and more aggressive management. This hemostatic resuscitation includes early activation of massive transfusion protocols with: 1) immediate delivery of blood packs with high ratios for RBC units: fresh frozen plasma: platelet-concentrates; 2) antifibrinolytics; 3) substitution of coagulation factors. However, early identification of coagulopathic patients requiring aggressive hemostatic resuscitation remains challenging, with an increasing role of point of care devices for hemostatic diagnosis and monitoring. Efforts have to be focused on the early diagnosis of coagulopathy for immediate delivery of blood products and coagulation factors to the right, accurately screened patients through pre-established protocols within the golden hour.
出血是创伤患者入院时存活但最终死亡的主要原因。此类出血具有“凝血病”成分，这是严重创伤所特有的，且与不良预后相关。在过去十年中，对这种创伤性凝血病的深入了解催生了一种新的治疗方法，即需要更早期、更积极的处理。这种止血复苏包括早期启动大量输血方案，具体措施如下：1）立即按高比例配送血制品，红细胞单位：新鲜冰冻血浆：血小板浓缩物；2）抗纤溶药物；3）补充凝血因子。然而，早期识别需要积极止血复苏的凝血病患者仍然具有挑战性，即时检测设备在止血诊断和监测中的作用日益凸显。必须致力于凝血病的早期诊断，以便在黄金时间内通过预先制定的方案，将血液制品和凝血因子及时准确地输送给经过精确筛选的合适患者。
