Leeds General Infirmary, Clarendon Wing, Level A, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK.
Eur J Trauma Emerg Surg. 2016 Jun;42(3):273-82. doi: 10.1007/s00068-015-0628-3. Epub 2016 Feb 4.
Damage control resuscitation describes an approach to the early care of very seriously injured patients. The aim is to keep the patient alive whilst avoiding interventions and situations that risk worsening their situation by driving the lethal triad of hypothermia, coagulopathy and acidosis or excessively stimulating the immune-inflammatory system. It is critical that the concepts and practicalities of this approach are understood by all those involved in the early management of trauma patients. This review aims to summarise this and discusses current knowledge on the subject.
Damage control resuscitation forms part of an overall approach to patient care rather than a specific intervention and has evolved from damage control surgery. It is characterised by early blood product administration, haemorrhage arrest and restoration of blood volume aiming to rapidly restore physiologic stability. The infusion of large volumes of crystalloid is no longer appropriate, instead the aim is to replace lost blood and avoid dilution and coagulopathy. In specific situations, permissive hypotension may also be of benefit, particularly in patients with severe haemorrhage from an arterial source. As rapid arrest of haemorrhage is so important, team-based protocols that deliver patients rapidly but safely, via CT scan where appropriate, to operating theatres or interventional radiology suites form a critical part of this process.
Given that interventions are so time dependent in the severely injured, it is likely that by further improving trauma systems and protocols, improvements in outcome can still be made. Further research work in this area will allow us to target these approaches more accurately to those patients who can benefit most.
损伤控制性复苏描述了一种针对严重创伤患者的早期治疗方法。其目的是在避免进一步加重病情的风险的同时，使患者保持存活，避免因引发致死三联征（低体温、凝血病和酸中毒）或过度刺激免疫炎症系统的干预和情况。所有参与创伤患者早期管理的人员都必须了解这一方法的概念和实用性。本文旨在对这一方法进行总结，并讨论当前该主题的知识。
损伤控制性复苏是患者治疗整体方法的一部分，而不是特定的干预措施，它源自损伤控制性手术。其特点是早期输注血液制品、止血和恢复血容量，以快速恢复生理稳定性。大量晶体液的输注不再合适，而是旨在替代丢失的血液，避免稀释和凝血病。在特定情况下，允许性低血压也可能有益，尤其是在动脉来源严重出血的患者中。由于快速止血非常重要，因此基于团队的方案，通过 CT 扫描将患者快速但安全地输送至手术室或介入放射学套房，是这一过程的关键部分。
鉴于严重创伤患者的干预措施非常依赖时间，因此通过进一步改善创伤系统和方案，仍有可能改善结果。在该领域的进一步研究工作将使我们能够更准确地将这些方法针对那些最能受益的患者。
