Datta R, Chaturvedi R
Associate Professor, Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune-40.
Professor & HOD, Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune-40.
Med J Armed Forces India. 2010 Oct;66(4):312-6. doi: 10.1016/S0377-1237(10)80006-1. Epub 2011 Jul 21.
Advances in shock resuscitation have occurred as a result of various military conflicts. Primary objective of trauma care is to minimize or reverse shock, avoiding the lethal triad of hypothermia, acidosis, and coagulopathy. The concept of Damage Control Resuscitation has evolved along with "damage control surgery" which includes hypotensive and haemostatic resuscitation, where small aliquots of fluid are infused, with hypovolaemia and hypotension tolerated as a necessary evil until definitive haemorrhage control can be achieved. In the initial stages of trauma resuscitation the precise fluid, crystalloid or colloid, used is probably not important as long as an appropriate volume is given. Haemostatic resuscitation includes early use of fresh frozen plasma in a 1:1 ratio with packed red cells with emphasis on whole blood, frequent cryo precipitates and platelets and the use of recombinant Factor VII for control of bleeding.
由于各种军事冲突，休克复苏取得了进展。创伤护理的主要目标是尽量减少或逆转休克，避免体温过低、酸中毒和凝血病这一致命三联征。损伤控制复苏的概念随着“损伤控制手术”而演变，后者包括低血压和止血复苏，即输注少量液体，将低血容量和低血压视为必要的弊端加以容忍，直到能够实现确定性出血控制。在创伤复苏的初始阶段，只要给予适当的容量，使用的精确液体（晶体液或胶体液）可能并不重要。止血复苏包括早期以1:1的比例使用新鲜冰冻血浆与红细胞悬液，强调使用全血、频繁使用冷沉淀和血小板，以及使用重组凝血因子VII控制出血。
