Winkelmann M, Wilhelmi M
Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland,
Unfallchirurg. 2014 Feb;117(2):99-104. doi: 10.1007/s00113-013-2487-x.
Polytrauma is the leading cause of morbidity and mortality in young adults (aged 35-45 years). At 30-40%, traumatic hemorrhage is the most frequent preventable cause of death. Approximately every fourth patient with multiple injuries suffers from trauma-induced coagulopathy.
The current knowledge of prehospital resuscitation of patients with multiple injuries based on a selective literature research and experience in a level I trauma center are presented.
Hemorrhagic shock is a clinical diagnosis and the recognition by the first responding emergency physician requires rapid evaluation of the accident situation, injury pattern and patient's hemodynamic status. In the future, tools will help to reliably estimate shock. Development of trauma-induced coagulopathy is multifactorial and is characterized by interaction of tissue damage, shock, hypothermia, acidosis and dilution. Preclinical therapy follows the concept of damage control resuscitation and involves bleeding hemostasis, permissive hypotension with a target systolic blood pressure between 80 and 90 mmHg (≥80 mmHg in presence of traumatic brain injury) by modest infusion of primarily crystalloid solutions, avoiding hypothermia and acidosis.
The current knowledge and therapy recommendations are presented.
多发伤是35至45岁青壮年发病和死亡的主要原因。创伤性出血是最常见的可预防死亡原因，占比30%-40%。约每四名多发伤患者中就有一名患有创伤性凝血病。
基于一级创伤中心的选择性文献研究和经验，介绍了多发伤患者院前复苏的现有知识。
失血性休克是一种临床诊断，首位急救医生的识别需要快速评估事故情况、损伤模式和患者的血流动力学状态。未来，一些工具将有助于可靠地评估休克。创伤性凝血病的发生是多因素的，其特征是组织损伤、休克、体温过低、酸中毒和稀释之间的相互作用。临床前治疗遵循损伤控制复苏的理念，包括止血、通过适度输注主要为晶体溶液使收缩压维持在80至90毫米汞柱（存在创伤性脑损伤时≥80毫米汞柱）的允许性低血压，避免体温过低和酸中毒。
介绍了现有知识和治疗建议。
