FRCSC, Dalhousie University, Halifax, NS, Canada.
University of Calgary, Calgary, AB, Canada.
Injury. 2020 May;51 Suppl 2:S123-S127. doi: 10.1016/j.injury.2020.04.040. Epub 2020 May 11.
Trauma is a major cause of mortality globally, with post-traumatic hemorrhage being the leading cause of death amongst trauma patients. In this paper, the authors review the underlying pathophysiology of trauma-related hemorrhagic shock, specifically the factors which contribute to the development of the acute coagulopathy of trauma shock (ACoTS). We then review the best available evidence for treatment strategies in the pre-hospital setting, as well as the in-hospital setting. Interventions that are strongly supported in the literature include utilization of a well-organized trauma system with direct transport to a designated trauma centre, the early use of tranexamic acid, and damage control orthopaedic surgical techniques and resuscitation protocols. Targeted resuscitation is an evolving field, with use of thromboelastography to guide resuscitation being a particularly promising area. Special trauma populations at particularly high risk are also reviewed, including the geriatric population, as well as unstable pelvic fractures, which are each at increased risk for poor outcomes, and deserve special attention. Major advances have been made in this important area, and ongoing research into the understanding and correction of ACoTS will continue to guide practice.
创伤是全球范围内导致死亡的主要原因之一，创伤后出血是创伤患者死亡的主要原因。本文作者回顾了与创伤相关的失血性休克的潜在病理生理学，特别是导致创伤性休克急性凝血病（ACoTS）发展的因素。然后，我们回顾了在院前和院内环境中治疗策略的最佳可用证据。在文献中得到强烈支持的干预措施包括利用组织良好的创伤系统，直接将患者转运到指定的创伤中心，早期使用氨甲环酸，以及采用损伤控制性骨科手术技术和复苏方案。靶向复苏是一个不断发展的领域，使用血栓弹性描记术来指导复苏是一个特别有前途的领域。特别审查了高危特殊创伤人群，包括老年人群以及不稳定骨盆骨折患者，这些患者的预后较差，风险增加，值得特别关注。在这个重要领域已经取得了重大进展，对 ACoTS 的理解和纠正的持续研究将继续指导实践。
