Palmer Lee, Martin Linda
Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849.
J Vet Emerg Crit Care (San Antonio). 2014 Jan-Feb;24(1):75-92. doi: 10.1111/vec.12138. Epub 2014 Jan 6.
To discuss the current resuscitative strategies for trauma-induced hemorrhagic shock and acute traumatic coagulopathy (ATC).
Hemorrhagic shock can be acutely fatal if not immediately and appropriately treated. The primary tenets of hemorrhagic shock resuscitation are to arrest hemorrhage and restore the effective circulating volume. Large volumes of isotonic crystalloids have been the resuscitative strategy of choice; however, data from experimental animal models and retrospective human analyses now recognize that large-volume fluid resuscitation in uncontrolled hemorrhage may be deleterious. The optimal resuscitative strategy has yet to be defined. In human trauma, implementing damage control resuscitation with damage control surgery for controlling ongoing hemorrhage, acidosis, and hypothermia; managing ATC; and restoring effective circulating volume is emerging as a more optimal resuscitative strategy. With hyperfibrinolysis playing an integral role in the manifestation of ATC, the use of antifibrinolytics (eg, tranexamic acid and aminocaproic acid) may also serve a beneficial role in the early posttraumatic period. Considering the sparse information regarding these resuscitative techniques in veterinary medicine, veterinarians are left with extrapolating information from human trials and experimental animal models.
Viscoelastic tests integrated with predictive scoring systems may prove to be the most reliable methods for early detection of ATC as well as for guiding transfusion requirements.
Hemorrhage accounts for up to 40% of human trauma-related deaths and remains the leading cause of preventable death in human trauma. The exact proportion of trauma-related deaths due to exsanguinations in veterinary patients remains uncertain. Survivability depends upon achieving rapid definitive hemostasis, early attenuation of posttraumatic coagulopathy, and timely restoration of effective circulating volume. Early institution of damage control resuscitation in severely injured patients with uncontrolled hemorrhage has the ability to curtail posttraumatic coagulopathy and the exacerbation of metabolic acidosis and hypothermia and improve survival until definitive hemostasis is achieved.
探讨创伤性失血性休克和急性创伤性凝血病（ATC）的当前复苏策略。
失血性休克若不立即进行适当治疗，可迅速致命。失血性休克复苏的主要原则是止血并恢复有效循环血容量。大量等渗晶体液一直是首选的复苏策略；然而，实验动物模型和回顾性人类分析的数据现在认识到，在未控制出血的情况下进行大量液体复苏可能有害。最佳复苏策略尚未确定。在人类创伤中，采用损伤控制复苏结合损伤控制手术来控制持续出血、酸中毒和体温过低；管理ATC；以及恢复有效循环血容量正成为一种更优的复苏策略。由于高纤维蛋白溶解在ATC的表现中起重要作用，使用抗纤维蛋白溶解剂（如氨甲环酸和氨基己酸）在创伤后早期也可能发挥有益作用。考虑到兽医医学中关于这些复苏技术的信息稀少，兽医只能从人体试验和实验动物模型中推断信息。
结合预测评分系统的粘弹性试验可能被证明是早期检测ATC以及指导输血需求的最可靠方法。
出血占人类创伤相关死亡的40%，仍然是人类创伤中可预防死亡的主要原因。兽医患者因失血导致的创伤相关死亡的确切比例仍不确定。生存率取决于能否迅速实现确定性止血、早期减轻创伤后凝血病以及及时恢复有效循环血容量。对严重受伤且出血未控制的患者尽早实施损伤控制复苏，有能力减少创伤后凝血病以及代谢性酸中毒和体温过低的加重，并提高生存率直至实现确定性止血。
