Shannon Gaasch is Senior Nurse Practitioner II, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201 (Shannon.
AACN Adv Crit Care. 2021 Mar 15;32(1):64-75. doi: 10.4037/aacnacc2021817.
Traumatic injury remains the leading cause of death among individuals younger than age 45 years. Hemorrhage is the primary preventable cause of death in trauma patients. Management of hemorrhage focuses on rapidly controlling bleeding and addressing the lethal triad of hypothermia, acidosis, and coagulopathy. The principles of damage control surgery are rapid control of hemorrhage, temporary control of contamination, resuscitation in the intensive care unit to restore normal physiology, and a planned, delayed definitive operative procedure. Damage control resuscitation focuses on 3 key components: fluid restriction, permissive hypotension, and fixed-ratio transfusion. Rapid recognition and control of hemorrhage and implementation of resuscitation strategies to control damage have significantly improved mortality and morbidity rates. In addition to describing the basic principles of damage control surgery and damage control resuscitation, this article explains specific management considerations for and potential complications in patients undergoing damage control interventions in an intensive care unit.
创伤仍然是 45 岁以下人群死亡的主要原因。出血是创伤患者死亡的主要可预防原因。出血的治疗重点在于迅速控制出血并解决体温过低、酸中毒和凝血功能障碍的三联致命问题。损伤控制性手术的原则是迅速控制出血、暂时控制污染、在重症监护病房复苏以恢复正常生理机能，以及计划进行延迟确定性手术。损伤控制性复苏侧重于 3 个关键组成部分：液体限制、允许性低血压和固定比例输血。迅速识别和控制出血并实施复苏策略以控制损伤，显著降低了死亡率和发病率。本文除了描述损伤控制性手术和损伤控制性复苏的基本原则外，还解释了在重症监护病房进行损伤控制性干预的患者的具体管理注意事项和潜在并发症。
