Gurney Jennifer M, Spinella Philip C
Uniformed Services University of Health Sciences, Bethesda, Maryland.
U.S. Army Institute of Surgical Research, JBSA-FT Sam, Houston, Texas.
Curr Opin Anaesthesiol. 2018 Apr;31(2):207-214. doi: 10.1097/ACO.0000000000000574.
Hemorrhage remains the primary cause of preventable death on the battlefield and in civilian trauma. Hemorrhage control is multifactorial and starts with point-of-injury care. Surgical hemorrhage control and time from injury to surgery is paramount; however, interventions in the prehospital environment and perioperative period affect outcomes. The purpose of this review is to understand concepts and strategies for successful management of the bleeding military patient. Understanding the life-threatening nature of coagulopathy of trauma and implementing strategies aimed at full spectrum hemorrhage management from point of injury to postoperative care will result in improved outcomes in patients with life-threatening bleeding.
Timely and appropriate therapies impact survival. Blood product resuscitation for life-threatening hemorrhage should either be with whole blood or a component therapy strategy that recapitulates the functionality of whole blood. The US military has transfused over 10 000 units of whole blood since the beginning of the wars in Iraq and Afghanistan. The well recognized therapeutic benefits of whole blood have pushed this therapy far forward into prehospital care in both US and international military forces. Multiple hemostatic adjuncts are available that are likely beneficial to the bleeding military patient; and other products and techniques are under active investigation.
Lessons learned in the treatment of combat casualties will likely continue to have positive impact and influence and the management of hemorrhage in the civilian trauma setting.
出血仍然是战场上和 civilian 创伤中可预防死亡的主要原因。出血控制是多因素的，始于受伤现场的救治。手术控制出血以及从受伤到手术的时间至关重要；然而，院前环境和围手术期的干预会影响治疗结果。本综述的目的是了解成功管理出血军事伤员的概念和策略。了解创伤性凝血病的危及生命的性质，并实施从受伤点到术后护理的全谱出血管理策略，将改善危及生命出血患者的治疗结果。
及时和适当的治疗会影响生存。对于危及生命的出血，血液制品复苏应使用全血或模拟全血功能的成分治疗策略。自伊拉克和阿富汗战争开始以来，美国军队已输注了超过 10000 单位的全血。全血公认的治疗益处已使这种治疗在美国和国际军事力量的院前护理中得到广泛应用。有多种止血辅助剂可能对出血的军事伤员有益；其他产品和技术正在积极研究中。
在战斗伤员治疗中吸取的经验教训可能会继续对 civilian 创伤环境中的出血管理产生积极影响。 （注：这里“civilian”直译为“平民的”，结合语境推测为“ civilian trauma setting”整体应是指平民创伤环境，但原文这个词使用可能有误，推测可能是“civilian”应改为“civilian's”之类的形式使表达更准确 ）
