Stein Philipp, Kaserer Alexander, Spahn Gabriela H, Spahn Donat R
Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
Semin Thromb Hemost. 2017 Jun;43(4):367-374. doi: 10.1055/s-0037-1598062. Epub 2017 Mar 15.
Trauma remains one of the major causes of death and disability all over the world. Uncontrolled blood loss and trauma-induced coagulopathy represent preventable causes of trauma-related morbidity and mortality. Treatment may consist of allogeneic blood product transfusion at a fixed ratio or in an individualized goal-directed way based on point-of-care (POC) and routine laboratory measurements. Viscoelastic POC measurement of the developing clot in whole blood and POC platelet function testing allow rapid and tailored coagulation and transfusion treatment based on goal-directed, factor concentrate-based algorithms. The first studies have been published showing that this concept reduces the need for allogeneic blood transfusion and improves outcome. This review highlights the concept of goal-directed POC coagulation management in trauma patients, introduces a selection of POC devices, and presents algorithms which allow a reduction in allogeneic blood product transfusion and an improvement of trauma patient outcome.
创伤仍然是全球主要的死亡和致残原因之一。失控性失血和创伤性凝血病是创伤相关发病和死亡的可预防原因。治疗方法可以是按照固定比例输注异体血制品，也可以根据即时检验（POC）和常规实验室检测结果以个体化目标导向的方式进行。通过对全血中正在形成的血凝块进行粘弹性POC检测以及POC血小板功能检测，可以根据目标导向、基于凝血因子浓缩物的算法进行快速且针对性的凝血和输血治疗。首批研究已经发表，表明这一理念减少了异体输血的需求并改善了治疗结果。本综述重点介绍了创伤患者目标导向的POC凝血管理概念，介绍了一些POC设备，并展示了能够减少异体血制品输注并改善创伤患者治疗结果的算法。
