Rappold Joseph F, Bochicchio Grant V
Department of Surgery, Division of Acute Care Surgery, Maine Medical Center/Tufts University School of Medicine, Portland, Maine.
Department of Surgery, Division of Acute and Critical Care Surgery, Washington University School of Medicine, St Louis, Missouri.
Transfusion. 2016 Apr;56 Suppl 2:S203-7. doi: 10.1111/trf.13585.
Despite the tremendous advances and successes in the care of combat casualties over the past 15 years of war, noncompressible torso hemorrhage (NCTH) remains the most likely source of potentially preventable death (approx. 25%) on the battlefield. This is also likely true for civilian victims of blunt and penetrating trauma. Various devices and therapeutic interventions have been, and are being, developed in an attempt to reduce morbidity and mortality for patients with NCTH. Examples include the use of prehospital blood and blood products, tranexamic acid, specially designed tourniquets for junctional hemorrhage control, retrograde endovascular balloon occlusion of the aorta, intracavity foam, expandable hemostatic sponges, and intravascular nanoparticles to suspended animation. Although each of these modalities offer the potential to staunch uncontrolled hemorrhage until an injured patient is able to reach definitive surgical care, further research and advances must be made to further reduce trauma morbidity and mortality and to identify those technologies and modalities that are best suited to rapid movement to the front lines of combat casualty care as well as to emergency medical personnel dealing with civilian trauma victims. The surgical adjuncts for NCTH discussed may all be considered as potential tools for patient blood management programs. If effective they offer the possibility of reduce hemorrhage and blood product exposure and improved patient outcomes.
尽管在过去15年的战争中，在战伤救治方面取得了巨大进展和成功，但不可压缩性躯干出血（NCTH）仍然是战场上潜在可预防死亡（约25%）的最可能来源。对于钝性和穿透性创伤的平民受害者来说，情况可能也是如此。为了降低NCTH患者的发病率和死亡率，已经开发并正在开发各种设备和治疗干预措施。例如，使用院前血液和血液制品、氨甲环酸、专门设计用于控制交界性出血的止血带、主动脉逆行血管内球囊闭塞术、腔内泡沫、可膨胀止血海绵以及用于诱导假死状态的血管内纳米颗粒。尽管这些方法中的每一种都有可能在受伤患者能够获得确定性手术治疗之前止住无法控制的出血，但必须进行进一步的研究和取得进展，以进一步降低创伤发病率和死亡率，并确定那些最适合迅速应用于战伤救治前线以及处理平民创伤受害者的紧急医疗人员的技术和方法。所讨论的NCTH手术辅助手段都可被视为患者血液管理计划的潜在工具。如果有效，它们有可能减少出血和血液制品暴露，并改善患者预后。
