a The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine , Witten/Herdecke University , Cologne , Germany.
b Department of Traumatology and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC) , Witten/Herdecke University , Cologne , Germany.
Expert Rev Hematol. 2018 Dec;11(12):987-995. doi: 10.1080/17474086.2018.1548929. Epub 2018 Nov 27.
: Despite advances in the treatment of severely injured patients that have resulted in overall improved outcomes, uncontrolled hemorrhage still represents the most common cause of preventable death following major injury. While addressing both endo- and exogenous factors that lead to an acute trauma-induced coagulopathy, massive transfusion plays a key role in managing bleeding trauma patients. However, the best practice for hemostatic control including massive transfusion in these patients is still under debate. : This review summarizes the current knowledge and clinical practice for hemostatic control including massive transfusion for bleeding trauma patients. The recent literature was reviewed and extended by current guidelines and their underlying evidence was incorporated. : Treatment strategies for bleeding trauma patients are still an area of emerging scientific and clinical interest as advances are likely to translate into improved outcomes including survival. To date, damage control resuscitation principles with ratio-based transfusion of packed red blood cells, plasma and platelets still dominate as "gold standard" of care but goal-directed strategies guided either by conventional coagulation tests or viscoelastic assays may demonstrate a better characterization of the underlying coagulopathy thereby allowing individualized and targeted therapies.
尽管在严重创伤患者的治疗方面取得了进展，总体上改善了治疗效果，但未控制的出血仍然是导致重大创伤后可预防死亡的最常见原因。虽然解决了导致急性创伤性凝血病的内源性和外源性因素，但大量输血在治疗出血性创伤患者方面起着关键作用。然而，在这些患者中进行止血控制（包括大量输血）的最佳实践仍存在争议。
本综述总结了目前关于出血性创伤患者止血控制（包括大量输血）的知识和临床实践。综述了最新的文献，并结合了当前的指南及其潜在证据。
出血性创伤患者的治疗策略仍然是一个新兴的科学和临床关注领域，因为进展可能会转化为改善结果，包括生存率。迄今为止，基于比例输注浓缩红细胞、血浆和血小板的损伤控制性复苏原则仍然是“金标准”治疗方法，但以常规凝血试验或粘弹性检测为指导的目标导向策略可能更好地描述潜在的凝血障碍，从而允许进行个体化和靶向治疗。
