Maegele M, Fröhlich M, Caspers M, Kaske S
Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Cologne, Germany.
Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany.
Eur J Trauma Emerg Surg. 2017 Aug;43(4):439-443. doi: 10.1007/s00068-017-0771-0. Epub 2017 Feb 27.
Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate.
A synopsis of best current knowledge with reference to the following guidelines and recommendations is presented: (1) The European Guideline on Management of Major Bleeding and Coagulopathy following Trauma (fourth edition), (2) S3 Guideline on Treatment of Patients with Severe and Multiple Injuries [English Version of the German Guideline S3 Leitlinie Polytrauma/Schwerverletzten-Behandlung/AWMF Register-Nr. 012/019 sponsored by the German Society for Trauma Surgery/Deutsche Gesellschaft für Unfallchirurgie (DGU)], and (3) S3 Guideline Intravascular Volume Treatment in the Adult [AWMF Register-Nr 001/020 sponsored by the German Society for Anesthesiology and Intensive Medicine/Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)].
Volume replacement at a reduced level in severely injured and bleeding trauma patients is advocated (permissive hypotension) until the bleeding is controlled. ATLS principles with Hb, BE, and/or lactate can assess perfusion, estimate/monitor the extent of bleeding/shock, and guide therapy. Isotonic crystalloid solutions are first-line and specific recommendations apply for patients with TBI.
血管内容量及液体补充仍是早期创伤复苏时纠正液体不足的基石，但最佳策略仍存在争议。
本文概述了当前最佳知识，并参考了以下指南和建议：（1）《欧洲创伤后大出血及凝血功能障碍管理指南》（第四版），（2）《严重多发伤患者治疗S3指南》[德国创伤外科学会（DGU）赞助的德国指南S3《多发伤/重伤患者治疗/AWMF登记号012/019》英文版]，以及（3）《成人血管内容量治疗S3指南》[德国麻醉学和重症医学学会（DGAI）赞助的AWMF登记号001/020]。
对于严重受伤且出血的创伤患者，在出血得到控制之前，主张采用较低水平的容量替代（允许性低血压）。高级创伤生命支持（ATLS）原则结合血红蛋白（Hb）、碱剩余（BE）和/或乳酸可评估灌注情况，估计/监测出血/休克程度并指导治疗。等渗晶体溶液是一线治疗方案，对于创伤性脑损伤（TBI）患者有特定的推荐。
