From the Department of Surgery, Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, AL.
J Trauma Acute Care Surg. 2023 Oct 1;95(4):464-471. doi: 10.1097/TA.0000000000004103. Epub 2023 Jun 29.
Death after injury is a worldwide epidemic. Hemorrhage as a cause of death represents the leading potentially preventable condition. Based on hard-won experience from the recent wars, and two decades of military and civilian research, damage-control resuscitation (DCR) is now widely used. This article will briefly describe the history of blood transfusion, outline "why we do DCR," and then discuss "how we do DCR." Modern DCR occurs both prehospital and in the hospital and has several main tenants. Currently, DCR focuses on the liberal use of temporary hemorrhage-control adjuncts, early use of whole blood or balanced blood product-based transfusions, mitigation of crystalloid use, hypotensive resuscitation to promote hemostasis and decrease coagulopathy, and correction of ongoing metabolic derangements, followed by rapid definitive hemorrhage control. These concepts have evolved from a series of lessons learned over time from both civilian and military trauma casualties, and DCR is now the standard of care in trauma resuscitation.
死亡是一个全球性的问题。出血是导致死亡的主要潜在可预防的原因。基于近年来战争中获得的宝贵经验，以及二十年来的军事和民用研究，损伤控制性复苏（DCR）现在已经得到广泛应用。本文将简要描述输血的历史，概述“为什么我们要进行 DCR”，然后讨论“如何进行 DCR”。现代的 DCR 既发生在院前，也发生在医院内，有几个主要的特点。目前，DCR 侧重于广泛使用临时止血辅助手段，早期使用全血或平衡的血液制品进行输血，减少晶体液的使用，低血压复苏以促进止血和减少凝血障碍，以及纠正持续的代谢紊乱，然后迅速进行确定性止血控制。这些概念是从民用和军事创伤伤员身上的一系列经验教训中逐步演变而来的，现在 DCR 已经成为创伤复苏的标准治疗方法。
