Hiippala S
Department of Anesthesiology, Helsinki University Central Hospital, Finland.
Vox Sang. 1998;74 Suppl 2:399-407. doi: 10.1111/j.1423-0410.1998.tb05449.x.
Treatment of massive blood loss has experienced major changes during the recent decade. The transition towards pure component therapy has been the most significant issue, which has compelled the clinician to revise some of their basic strategies in treatment of massively bleeding patients. The importance of adequate volume resuscitation with crystalloids and colloids is still unrefutable, but the therapy of hemorrhagic derangements has changed. Plasma-poor red cells (RC) are now commonly used instead of whole blood (WB) or packed red blood cells (PRBC) to correct oxygen carrying capacity during massive blood loss. As the plasma content of RC is minimal, deficit of plasma and coagulation factors develops earlier than during transfusion of WB and PRBC. Hypofibrinogenemia develops first followed by other coagulation factor deficits and later by thrombocytopenia. Therefore the use of fresh frozen plasma (FFP) is the primary intervention to treat abnormal bleeding encountered in the replacement of massive blood loss with RC. As the development of thrombocytopenia is a highly individual phenomenon, the transfusion of platelets should be guided by repeatedly determined platelet counts.
在最近十年中，大量失血的治疗经历了重大变革。向纯成分疗法的转变是最为显著的问题，这迫使临床医生重新审视他们在治疗大量出血患者时的一些基本策略。使用晶体液和胶体液进行充分的容量复苏的重要性仍然无可争议，但出血紊乱的治疗方法已经改变。现在，在大量失血期间，常用少浆红细胞（RC）代替全血（WB）或浓缩红细胞（PRBC）来纠正氧携带能力。由于RC的血浆含量极少，与输注WB和PRBC相比，血浆和凝血因子的缺乏出现得更早。首先出现低纤维蛋白原血症，随后出现其他凝血因子缺乏，最后出现血小板减少。因此，使用新鲜冰冻血浆（FFP）是治疗在用RC替代大量失血时遇到的异常出血的主要干预措施。由于血小板减少的发生是一个高度个体化的现象，血小板输注应以反复测定的血小板计数为指导。
