Chang Ronald, Eastridge Brian J, Holcomb John B
Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX (Drs Chang and Holcomb).
Department of Surgery, University of Texas Health Science Center, San Antonio, TX (Dr Eastridge).
Wilderness Environ Med. 2017 Jun;28(2S):S124-S134. doi: 10.1016/j.wem.2017.02.002.
Hemorrhage is the leading cause of preventable military and civilian trauma death. Damage control resuscitation with concomitant mechanical hemorrhage control has become the preferred in-hospital treatment of hemorrhagic shock. In particular, plasma-based resuscitation with decreased volumes of crystalloids and artificial colloids as part of damage control resuscitation has improved outcomes in the military and civilian sectors. However, translation of these principles and techniques to the prehospital, remote, and austere environments, known as remote damage control resuscitation, is challenging given the resource limitations in these settings. Rapid administration of tranexamic acid and reconstituted freeze-dried (lyophilized) plasma as early as the point of injury are feasible and likely beneficial, but comparative studies in the literature are lacking. Whole blood is likely the best fluid therapy for traumatic hemorrhagic shock, but logistical hurdles need to be addressed. Rapid control of external hemorrhage with hemostatic dressings and extremity tourniquets are proven therapies, but control of noncompressible hemorrhage (ie, torso hemorrhage) remains a significant challenge.
出血是可预防的军事和民用创伤死亡的主要原因。伴随机械性出血控制的损伤控制复苏已成为出血性休克在医院内的首选治疗方法。特别是，作为损伤控制复苏的一部分，减少晶体液和人工胶体的用量并采用基于血浆的复苏方法，已改善了军事和民用领域的治疗效果。然而，鉴于这些环境中的资源限制，将这些原则和技术应用于院前、偏远和严峻环境（即远程损伤控制复苏）具有挑战性。在受伤时尽早快速给予氨甲环酸和冻干（冻干）血浆是可行的，而且可能有益，但文献中缺乏比较研究。全血可能是创伤性出血性休克的最佳液体疗法，但后勤障碍需要解决。使用止血敷料和肢体止血带快速控制外部出血是经证实的疗法，但控制不可压缩出血（即躯干出血）仍然是一项重大挑战。
