Uniformed Services University, Blood Research Program, US Army Institute of Surgical Research, Sam Houston, Texas, USA.
Anaesthesia. 2015 Jan;70 Suppl 1:96-101, e32-4. doi: 10.1111/anae.12914.
Over the last 10 years, the management of major haemorrhage in trauma patients has changed radically. This is mainly due to the recognition that many patients who are bleeding when they come in to the emergency department have an established coagulopathy before the haemodilution effects of fluid resuscitation. This has led to the use of new terminology: acute traumatic coagulopathy, acute coagulopathy of trauma shock or trauma-induced coagulopathy. The recognition of acute traumatic coagulopathy is important, because we now understand that its presence is a prognostic indicator, as it is associated with poor clinical outcome. This has driven a change in clinical management, so that the previous approach of maintaining an adequate circulating volume and oxygen carrying capacity before, as a secondary event, dealing with coagulopathy, has changed to haemostatic resuscitation as early as possible. While there is as yet no universally accepted assay or definition, many experts use prolongation of the prothrombin time to indicate that there is, indeed, a coagulopathy. Hypoxia, acidosis and hypothermia and hormonal, immunological and cytokine production, alongside consumption and blood loss, and the dilutional effects of resuscitation may occur to varying extents depending on the type of tissue damaged, the type and extent of injury, predisposing to, or amplifying, activation of coagulation, platelets, fibrinolysis. These are discussed in detail within the article.
在过去的 10 年中，创伤患者大出血的管理发生了根本性的变化。这主要是因为人们认识到，许多在进入急诊科时正在出血的患者在液体复苏的血液稀释作用之前就已经存在凝血障碍。这导致了新术语的出现：急性创伤性凝血病、创伤性休克急性凝血病或创伤诱导性凝血病。认识到急性创伤性凝血病很重要，因为我们现在了解到它的存在是一个预后指标，因为它与不良的临床结果相关。这推动了临床管理的改变，因此，以前在处理凝血障碍之前保持足够的循环血量和携氧能力的方法，已经转变为尽早进行止血复苏。虽然目前还没有普遍接受的检测或定义，但许多专家使用凝血酶原时间的延长来表示确实存在凝血障碍。缺氧、酸中毒和低体温以及激素、免疫和细胞因子的产生，加上消耗和失血，以及复苏的稀释作用，可能会根据受损组织的类型、损伤的类型和程度、易感性或放大作用而有所不同凝血、血小板、纤维蛋白溶解的激活。这些在文章中都有详细讨论。
