From the Division of Pediatric Surgery, Department of Surgery (R.T.R.), University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama; and Department of Surgery and Critical Care Medicine (C.M.L., P.C.S.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Trauma Acute Care Surg. 2023 Oct 1;95(4):472-480. doi: 10.1097/TA.0000000000004081. Epub 2023 Jun 12.
Damage-control resuscitation (DCR) consists of rapid control of bleeding, avoidance of hemodilution, acidosis, and hypothermia; early empiric balanced transfusions with red blood cells, plasma and platelets, or whole blood when available, and the use of intravenous or mechanical hemostatic adjuncts when indicated. The principles used in pediatric and adult trauma patients are quite similar. There are very important recognized physiologic differences in children with traumatic hemorrhagic shock that warrant slight variations in DCR. In pediatric trauma patients, early physiologic signs of shock may be different from adults and the early recognition of this is critical to enable prompt resuscitation and utilization of damage control principles. This review details the current principles of pediatric DCR based on the best available literature, expert consensus recommendations, and also describes a practical guide for implementation of DCR strategies for pediatric trauma patients.
损伤控制性复苏（DCR）包括快速控制出血、避免血液稀释、酸中毒和低体温；早期经验性平衡输血，输注红细胞、血浆和血小板，或在有条件时输注全血，并在需要时使用静脉内或机械止血辅助手段。儿科和成人创伤患者使用的原则非常相似。创伤性失血性休克的儿童存在非常重要的公认的生理差异，这需要在 DCR 中进行轻微的调整。在儿科创伤患者中，休克的早期生理征象可能与成人不同，早期识别这一点对于实现快速复苏和使用损伤控制性原则至关重要。本综述根据现有最佳文献、专家共识建议详细介绍了儿科 DCR 的当前原则，并描述了儿科创伤患者实施 DCR 策略的实用指南。
