Transfusion practices in trauma.
Transfusion practices in trauma.
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DOI：
10.4103/0019-5049.144668
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发表时间：
2014-09
影响因子：
2.9
通讯作者：
Cattamanchi S
中科院分区：
文献类型：
--
作者：
Ramakrishnan VT;Cattamanchi S
在创伤患者中，使用晶体或胶体连同血液制品对严重创伤患者进行复苏是一种常见的输血做法。这篇综述文章的目的是更新目前创伤输血的做法。检索PubMed，谷歌Scholar和已发表研究的参考书目，使用关键词组合进行。对2000年至2014年创伤中输血实践的最新文章进行了识别和回顾。外伤引起的凝血因子消耗和稀释、酸中毒和低温在严重损伤患者中通常会引起外伤引起的凝血功能障碍。早期输注血液制品和早期控制出血可减少创伤性凝血病。低体温和稀释性凝血功能障碍与大量晶体的输注有关。因此，主要的重点是损害控制复苏，这是容许性低血压，出血控制和止血复苏的结合。大量输血方案可提高严重受伤患者的存活率。早期认识到病人需要大量输血将限制晶体药物的使用。在复苏初期，重伤员应按1:1:1的比例输注新鲜冷冻血浆、红细胞和血小板。新鲜全血可作为需要输入1:1:1解冻血浆、红细胞和血小板的患者的替代选择。采用密切监测出血和护理点凝血试验，允许定向血浆、红细胞和血小板输注，以降低输注相关急性肺损伤的风险。
Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.