Hamiliton S M, Breakey P
Department of Surgery, University of Alberta Hospitals, University of Alberta, Edmonton, Alta.
Can J Surg. 1996 Feb;39(1):11-6.
Patient management in the prehospital resuscitative phase after trauma is vitally important to the outcome. Early definitive care remains the essential element in improving morbidity and mortality. In Canada, where a large proportion of trauma occurs at sites distant from a trauma centre, the prehospital resuscitative phase is long and has even greater potential to affect outcome. Conventional teaching about the end points of resuscitation has promoted the concept of normalization of hemodynamic parameters with maintenance of end-organ perfusion, as measured by the hourly urine output. Recent work in patients with a closed head injury and in patients with penetrating torso trauma challenge the notion that trauma patients are homogeneous with respect to these end points. In the Canadian setting of blunt injury, where a closed head injury is usually suspected and often present, the evidence from clinical studies suggests that an aggressive approach to maintaining blood pressure is warranted. In penetrating torso injury in an urban setting, there is evidence to suggest that delaying resuscitation until hemorrhage is controlled is beneficial. More Canadian clinical trials are required in this area. In the meantime, the priorities of resuscitation must be carefully assessed for each patient and pattern of injury.
创伤后院前复苏阶段的患者管理对治疗结果至关重要。早期确定性治疗仍然是改善发病率和死亡率的关键因素。在加拿大，很大一部分创伤发生在远离创伤中心的地方，院前复苏阶段较长，对治疗结果的影响潜力更大。关于复苏终点的传统教学促进了通过维持每小时尿量来衡量的血流动力学参数正常化以及维持终末器官灌注的概念。最近针对闭合性颅脑损伤患者和穿透性躯干创伤患者的研究对创伤患者在这些终点方面具有同质性的观点提出了挑战。在加拿大钝性损伤的情况下，通常怀疑并经常存在闭合性颅脑损伤，临床研究证据表明采取积极措施维持血压是必要的。在城市环境中的穿透性躯干损伤中，有证据表明在出血得到控制之前延迟复苏是有益的。该领域需要更多的加拿大临床试验。与此同时，必须针对每个患者和损伤模式仔细评估复苏的优先事项。
