严重创伤出血救治中的生命支持  

Life support in care of severe traumatic hemorrhage

作　　者：张连阳 李阳 Zhang Lianyang;Li Yang(State Key Laboratory of Trauma,Burns and Composite Injury,Center of Trauma and War injury,Daping Hospital,Army Medical University of PLA,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院,战创伤医学中心,创伤、烧伤与复合伤国家重点实验室,重庆400042

出　　处：《中华创伤骨科杂志》2021年第5期369-372,共4页Chinese Journal of Orthopaedic Trauma

基　　金：陆军军医大学临床技术创新培育项目(CX2019JS109)。

摘　　要：失血性休克和致死性出血是战伤和非战伤死亡的主要原因,占手术室内死亡的80%以上,占创伤24 h内死亡的70%以上。此类患者救治是创伤中心建设面临的主要挑战和核心问题。院前损害控制性复苏措施,包括遵循ABCs法则,基于院前转运时间实施相应的输血、输液策略,基于具体伤情维持血压、使用氨甲环酸等;院内损害控制性复苏的核心是大量输血,及早纠正创伤性凝血病。院前损害控制性外科主要包括颈椎等脊柱的保护、骨盆带固定、胸腔闭式引流、直接压迫止血等,针对不可压迫致命性出血的复苏性主动脉球囊阻断术是最有希望的救命技术。院内损害控制性外科包括损害控制性剖腹、剖胸、骨科手术和开颅手术等。只有在黄金时间内配合实施损害控制性外科手术和损害控制性复苏,才能最终挽救此类严重创伤患者的生命。Hemorrhagic shock and lethal massive hemorrhage are leading causes of death in both combat and civilian trauma casualties,accounting for more than 80%of deaths in operating rooms and 70%of deaths within 24 hours after trauma.Management of such patients is the main challenge and core competence in establishment of a trauma center.Damage-control resuscitation measures in pre-hospital settings include following ABCs rules,implementing appropriate transfusion and infusion strategies based on pre-hospital transport time,maintaining blood pressure based on a specific injury,and using tranexamic acid.The core of damage-controlled resuscitation in in-hospital settings is early correction of traumatic coagulopathy by massive transfusion.Damage-control surgery in pre-hospital settings consists mainly in cervical spine protection,pelvic band fixation,thoracic drainage,direct compression hemostasis,etc.Resuscitation aortic balloon occlusion for non-compression lethal hemorrhage is the most promising life-saving means.Damage-control surgery in in-hospital settings includes damage control laparotomy,thoracotomy,orthopedic surgery and craniotomy.Only a combination of damage-control surgery and damage-controlled resuscitation in prime time can ultimately save patients with such severe trauma.

关 键 词：创伤和损伤 出血 生命支持疗法 损害控制 

分 类 号：R641[医药卫生—外科学]