Цитата:
Сообщение от zubarew
У больных с массивной (действительно массивной) кровопотерей они используют максимально рано донорскую плазму, эритроциты в достаточно большом объеме - не дожидаясь болюса в 2000, как прописано в ATLS, и стараются как можно меньше использовать искусственных коллоидов.
Практика "гемостатической реанимации", насколько мне известно, повсеместно принята в военной медицине западных стран. На "гражданке" дело идет медленней - большинство лечат по ATLS, но во многих весьма авторитетных травма-центрах уже принята в рутинной практике вышеупомянутая концепция.
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Приведу тезисы недавней публикации, поддерживающие вышеозвученные принципы:
The transfusion approach to massive hemorrhage has continually evolved since it began in the
early 1900s. It started with fresh whole blood and currently consists of virtually exclusive use of component and crystalloid therapy.
Recent US military experience has reinvigorated the debate on what the most optimal transfusion strategy is for patients with traumatic hemorrhagic shock. In this review we discuss recently described mechanisms that contribute to traumatic coagulopathy, which include
increased anti-coagulation factors and hyperfibrinolysis. We also describe the concept of damage control resuscitation (DCR), an early and aggressive prevention and treatment of hemorrhagic shock for patients with severe life-threatening traumatic injuries. The central tenants of DCR include hypotensive resuscitation, rapid surgical control, prevention and treatment of acidosis, hypothermia, and hypocalcemia,
avoidance of hemodilution, and hemostatic resuscitation with transfusion of red blood cells, plasma, and platelets in a 1:1:1 unit ratio and the a
ppropriate use of coagulation factors such as rFVIIa and fibrinogen-containing products (fibrinogen concentrates, cryoprecipitate). Fresh whole blood is also part of DCR in locations where it is available. Additional concepts to DCR since its original description that can be considered are the
preferential use of "fresh" RBCs, and when available thromboelastography to direct blood product and
hemostatic adjunct (anti-fibrinolytics and coagulation factor) administration.
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Blood Rev. 2009 Nov;23(6):231-40.
Resuscitation and transfusion principles for traumatic hemorrhagic shock.