创伤大量输血治疗方案的研究进展  

Current opinions on massive transfusion protocol in trauma patients

作　　者：王吉文[1,2] 王连[1,2] 张茂[1,2] 

机构地区：[1]浙江大学医学院附属第二医院急诊医学科 [2]浙江大学急救医学研究所,浙江杭州310009

出　　处：《创伤外科杂志》2013年第1期79-82,共4页Journal of Traumatic Surgery

基　　金：浙江省重大科技专项和优先主题项目(2009C03010-3);浙江省教育厅科研项目(Y201119819)

摘　　要：输血是创伤救治中的重要措施,许多学者建议制定大量输血治疗方案(massive transfusion pro-tocol,MTP)来指导输血及相关的治疗。本文主要讨论实施MTP的目的,能够减少血液制品输注量、提高输注效率、早期纠正创伤性凝血病和减少输血并发症等等。关于MTP的启动和终止目前尚无统一标准,由各医疗单位自行制定。启动MTP还依靠主观的经验判断,也有学者提出客观的评分法,但有待进一步验证。MTP是以标准流程的形式指导大出血和创伤性凝血病的治疗,涉及浓缩红细胞(RBC)、新鲜冰冻血浆(FFP)、血小板和冷沉淀输注以及重组Ⅶ因子(rFⅦa)的使用时机、剂量和目标等等,需要创伤外科、急诊科、血库、检验科和麻醉科等部门的通力协作。已有的大量实践证实,实施MTP可以减少血制品使用总量,提高输注效率;减轻创伤性凝血病的严重程度;降低脏器功能衰竭发生率、改善严重创伤患者的生存率;可能减少输血相关的并发症。MTP的实施中也存在诊疗标准不一致、血液成份的最佳输注比例不明确、对早期死亡的大出血患者的作用不确切等问题,需要进一步研究和解决。Transfusion is one of the most important therapies in trauma care. It has been widely advised to implement a massive transfusion protocol （MTP） to guide transfusion. In this review, we discussed the purpose of MTP,including reducing the amount of blood products transfused, improving the efficiency of transfusion, early cor- rection of traumatic coagulopathy and reducing transfusion-realated complications. Since no agreement has been reached on the criteria for starting and stopping MTP, these vary among different institutions. Initiation of MTP was mostly based on the subjective judgement ofthe doctors. Some scoring systems have been proposed , but needing fur- ther research. MTP is a standard process to guide the treatment of massive bleeding and traumatic eoagulopathy, which involves the timing, dose and aim of utilization of packed red blood cell, fresh frozen plasma, platelets, eryopre- cipitate and recombinant VII factor （ rF Vg a ） , and thorough collaboration is required among different departments such as trauma surgery, emergency department, blood bank, clinical laboratory and anesthesiology. It has been confirmed that the implementation of MTP could reduce the amount of blood products used,improve transfusion efficien- cy, reduce the severity of traumatic eoagulopathy and the morbility of organ failure,improve the survival rate of major trauma and reduce the transfusion-related complications. There are still some unsolved problems of MTP, including the criteria for diagnosis and management of massive transfusion, the best proportion of blood components, effect on these patients with massive bleeding and early death, which deserve further study.

关 键 词：创伤 输血 预后 

分 类 号：R457.1[医药卫生—治疗学]