Theusinger Oliver M, Stein Philipp, Spahn Donat R
Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland.
Curr Opin Anaesthesiol. 2014 Apr;27(2):225-32. doi: 10.1097/ACO.0000000000000041.
The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed.
Early administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia.
Applying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients.
本综述旨在强调氨甲环酸的应用、即时检验、基于算法使用凝血因子浓缩物治疗创伤相关凝血病以减少失血和输血需求从而改善预后。此外，还将讨论服用新型口服抗凝剂患者的管理、重新受到关注的药物以及创伤情况下对相对低血红蛋白水平的耐受性。
早期使用氨甲环酸可降低死亡率且不增加血栓栓塞事件风险。越来越推荐即时检验。使用凝血因子浓缩物的目标导向个体化凝血算法可减少异体血制品的输注量。用新型口服抗凝剂之一治疗创伤患者具有挑战性。此外，还发现了如深度神经肌肉阻滞等新机制以更好地耐受急性贫血。
将患者血液管理概念应用于创伤患者是可行且有效的。氨甲环酸等抗纤溶药物、即时检验以及使用凝血因子浓缩物的凝血算法可减少输血次数、降低成本，并可能改善严重创伤患者的预后。
