出血占所有创伤相关死亡率的30%至40%。在成年创伤患者中,94%的出血相关死亡发生在24小时内,约60%的死亡发生在入院后3小时内。因此,适当的出血初始液体复苏对于避免可预防的创伤相关死亡至关重要.特别是,复苏策略必须设计为补充及时纠正贫血,凝血功能障碍,和血小板减少症.患有严重创伤和大出血的患者的常规损伤控制复苏(DCR)通常开始于快速输注1000至2000mL的晶体状液,随后输注不含血浆的O型或不交叉匹配的红细胞(RBC),例如新鲜冷冻血浆(FFP)或血小板(PLT)。然而,这种DCR技术通常会导致一些不良事件,如腹腔室综合征,急性呼吸窘迫综合征,多器官衰竭,和稀释性凝血功能障碍。最近建议同时输注FFP和PLT以及第一批红细胞,同时尽量减少晶体输注,作为更新的DCR策略。FFP和PLT的这种积极的RBC输注不仅对于纠正凝血病和血小板减少症至关重要,而且有可能确保创伤患者的良好结果。此外,维持FFP/RBC和PLT/RBC的复苏比很重要。最近,DCR已被提倡通过早期施用FFP的混合物来快速控制出血,PLTs,和红细胞的平衡比为1:1:1。
Hemorrhage is responsible for 30 to 40% of all trauma-related mortality. Among adult trauma patients, 94% of hemorrhage-related deaths occur within 24 h and approximately 60% of these deaths within 3 h of hospital admission. Therefore, appropriate initial fluid resuscitation for bleeding is crucial to avoid preventable trauma-related death. In particular, the resuscitation strategy must be designed to complement prompt correction of anemia, coagulopathies, and thrombocytopenia. Conventional damage control resuscitation (DCR) of patients with severe trauma and massive hemorrhage is usually begun with rapid infusion of 1000 to 2000 mL of crystalloid fluids with subsequent transfusion of type O or uncross-matched red blood cells (RBCs) without plasma such as fresh frozen plasma (
FFP) or platelets (PLTs). However, this DCR technique often leads to several adverse events such as abdominal compartment syndrome, acute respiratory distress syndrome, multiple organ failure, and dilutional coagulopathy. Simultaneous transfusion of
FFP and PLTs along with the first units of RBCs while minimizing crystalloid infusion was recently recommended as a renewed DCR strategy. This aggressive RBC transfusion with
FFP and PLTs is not only essential for the correction of coagulopathies and thrombocytopenia but also has the potential to ensure a good outcome in trauma patients. Additionally, it is important to maintain the resuscitation ratios of
FFP/RBC and PLT/RBC. Most recently, DCR has been advocated for rapid hemorrhage control through early administration of a mixture of
FFP, PLTs, and RBCs in a balanced ratio of 1:1:1.