运用血栓弹力图管理创伤性凝血病
Management of Trauma-Induced Coagulopathy with Thrombelastography.
作者信息
Gonzalez Eduardo, Moore Ernest E, Moore Hunter B
机构信息
Department of Surgery, University of Colorado, 12700 East 19th Avenue, Denver, CO 80045, USA.
Department of Surgery, University of Colorado, 12700 East 19th Avenue, Denver, CO 80045, USA; Department of Surgery, Denver Health Medical Center, 77 Bannock Street, Denver, CO 80204, USA; Editorial office, Journal of Trauma and Acute Care Surgery, 655 Broadway, Suite 365, Denver, CO 80203, USA.
出版信息
Crit Care Clin. 2017 Jan;33(1):119-134. doi: 10.1016/j.ccc.2016.09.002.
Abstract
Viscoelastic assays, such as thrombelastography (TEG) and rotational thrombelastometry (ROTEM), have emerged as point-of-care tools that can guide the hemostatic resuscitation of bleeding injured patients. This article describes the role of TEG in contemporary trauma care by explaining this assay's methodology, clinical applications, and result interpretation through description of supporting studies to provide the reader with an evidence-based user's guide. Although TEG and ROTEM are assays based on the same viscoelastic principle, this article is focused on data supporting the use of TEG in trauma, because it is available in trauma centers in North America; ROTEM is mostly available in Europe.
摘要
黏弹性检测，如血栓弹力图（TEG）和旋转血栓弹力测定法（ROTEM），已成为可指导出血受伤患者进行止血复苏的即时检测工具。本文通过解释该检测方法、临床应用以及通过对支持性研究的描述进行结果解读，来描述TEG在当代创伤护理中的作用，为读者提供一份基于证据的用户指南。尽管TEG和ROTEM是基于相同黏弹性原理的检测方法，但本文重点关注支持TEG在创伤中应用的数据，因为它在北美的创伤中心可用；ROTEM大多在欧洲可用。
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J Trauma Acute Care Surg. 2017 Jan;82(1):114-119. doi: 10.1097/TA.0000000000001270.
2
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JAMA. 2016 Jun 14;315(22):2465-7. doi: 10.1001/jama.2016.5978.
3
Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays.创伤性凝血病的目标导向性止血复苏：一项比较黏弹性检测与传统凝血检测的实用随机临床试验
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4
Use of fibrinogen concentrate in bleeding patients.纤维蛋白原浓缩物在出血患者中的应用。
Anaesthesia. 2015 Nov;70(11):1323-4. doi: 10.1111/anae.13236.
5
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J Am Coll Surg. 2015 May;220(5):872-9. doi: 10.1016/j.jamcollsurg.2015.01.026. Epub 2015 Mar 31.
6
Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the Resuscitation Outcomes Consortium.复苏结果联盟的休克和创伤性脑损伤高渗盐水试验中所有死亡情况的详细描述。
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J Trauma Acute Care Surg. 2014 Dec;77(6):811-7; discussion 817. doi: 10.1097/TA.0000000000000341.
8
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Surgery. 2014 Sep;156(3):570-7. doi: 10.1016/j.surg.2014.04.030. Epub 2014 Jun 21.
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Anaesthesia. 2014 Aug;69(8):883-90. doi: 10.1111/anae.12748. Epub 2014 May 20.
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