摘要
目前,大量输血(massive transfusion,MT)仍是失血性休克病人在尚未明确止血前的主要救治手段。既往的MT要求快速输注红细胞和晶体液以维持机体有效循环血容量和组织氧供,而忽视了凝血因子和血小板的补充,导致稀释性凝血病和发生"出血的恶性循环(bloody viciouscycle)",使失血性休克的病死率仍处于较高水平。随着现代医学的不断进步,现在MT强调"止血性复苏(hemostaticresuscitation)"概念,增强补充凝血因子,建议以1:1:1的比例输注压积红细胞、新鲜冰冻血浆及血小板,并且在未明确止血前减少等渗晶体液输注和实施允许性低血压复苏。一旦出血得到控制,应立即减少或停止输血,以降低后期输血相关并发症的发生率。
Massive transfusion （MT） is still used for the treatment of hemorrhage shock before definitive control of life-threatening hemorrhage. The goal of MT in past years was to quickly supply isotonic crystalloids and plasma-poor RBC concentrates to maintain normovolemia and tissue oxygen supply. However, it frequently led to dilutional coagulopathy and ＂bloody vicious cycle＂, which led the mortality rates of hemorrhage shock still at a high level. With the development of modern medicine, MT emphasizes the ＂hemostatie resuscitation＂ with increased use of plasma and platelet, and advocate a 1：1：1 ratio of packed RBCs to fresh frozen plasma to platelet transfusions. At the same time, reduction in the use of isotonic crystalloid transfusion and ＂hypotensive＂ resuscitation are used before hemorrhage is controlled. Once definitive control of hemorrhage has been established, a restrictive approach to blood transfusion should be implemented to minimize the adverse of blood transfusion.
出处
《中国实用外科杂志》
CSCD
北大核心
2012年第11期910-912,共3页
Chinese Journal of Practical Surgery
关键词
大量输血
止血性复苏
massive transfusion
hemostatic resuscitation
