Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research, University of Texas Health Medical School, Houston, TX; and.
Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; The Trauma Centre, Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Blood. 2014 Nov 13;124(20):3052-8. doi: 10.1182/blood-2014-05-575340. Epub 2014 Oct 7.
Massive hemorrhage is associated with coagulopathy and high mortality. The transfusion guidelines up to 2006 recommended that resuscitation of massive hemorrhage should occur in successive steps using crystalloids, colloids, and red blood cells (RBCs) in the early phase and plasma and platelets in the late phase. With the introduction of the cell-based model of hemostasis in the mid-1990s, our understanding of the hemostatic process and of coagulopathy has improved. This has contributed to a change in resuscitation strategy and transfusion therapy of massive hemorrhage along with an acceptance of the adequacy of whole blood hemostatic tests to monitor these patients. Thus, in 2005, a strategy aiming at avoiding coagulopathy by proactive resuscitation with blood products in a balanced ratio of RBC:plasma:platelets was introduced, and this has been reported to be associated with reduced mortality in observational studies. Concurrently, whole blood viscoelastic hemostatic assays have gained acceptance by allowing a rapid and timely identification of coagulopathy along with enabling an individualized, goal-directed transfusion therapy. These strategies joined together seem beneficial for patient outcome, although final evidence on outcome from randomized controlled trials are lacking. We present how we in Copenhagen and Houston, today, manage patients with massive hemorrhage.
大出血与凝血功能障碍和高死亡率相关。直至 2006 年的输血指南建议，在早期阶段应使用晶体液、胶体液和红细胞（RBC）进行连续复苏，在晚期阶段则使用血浆和血小板进行复苏。随着 20 世纪 90 年代中期止血的细胞模型的引入，我们对止血过程和凝血功能障碍的认识得到了提高。这导致了大出血复苏策略和输血治疗的改变，同时也接受了使用全血止血检测来监测这些患者的充分性。因此，2005 年，引入了一种策略，旨在通过以 RBC:血浆:血小板的平衡比例积极地用血液制品进行复苏来避免凝血功能障碍，并且据观察研究报告称，该策略与降低死亡率相关。同时，全血黏弹性止血检测的应用得到了认可，因为它可以快速及时地识别凝血功能障碍，并能够实现个体化、目标导向的输血治疗。尽管缺乏来自随机对照试验的关于结果的最终证据，但这些策略似乎对患者的预后有益。我们介绍了哥本哈根和休斯顿的团队如今如何治疗大出血患者。
