Aktualne spojrzenie na masywny krwotok actual view-point for massive hemorrhage
DOI:
https://doi.org/10.15587/2313-8416.2015.42078Ключевые слова:
krzepnięcia, utrata krwi, urazami wojennymi, terroryzmem, fibrynogenu, tromboelastografiaАннотация
Masywna utrata krwi związana z urazami wojennymi, terroryzmem, wypadkami komunikacyjnymi i innymi czynnikami stanowią główną pzryczynę śmierci. Pierwsze godziny krwotoku są połączone ze spadkiem potencjału krzepnięcia i rozwoju koagulopatii w połączeniu ze spadkiem temperatury ciała i rozwoju kwasicy metabolicznej co stanowi bardzo poważne zagrożenie zyciu. W związku z tym obecne podejście do leczenia masywnego krwotoku opiera się na unikaniu nadmiernej transfusji płynów, ponieważ prowadzi to do rozcieńczenia składników układu krzepnięcia. Często jest uzywane świeżo mrożone osocze, lub koncentrat protrombiny jako źródło fibrynogenu. Tromboelastografia jest zalecana do rozpoznania masywnego krwotoku. W podejściu do leczenia stanów zagrożenia życia, związanych z urazem, obowiązuje zasada damage control resuscitation, czyli wykonanie tylko niezbędnych czynności ratujących życie na pierwszej linii postępowania.
W masywnym krwotoku uzasadnione: staza krwotoku na miejscu zdarzenia, staza chirurgiczna, rozpoczęcie resuscytacji przy użyciu pełnej świeżej lub świeżej ciepłej krwi. Przetaczaniu preparatów krwi musi zachować stosunek krwinek czerwonych/FFP/trombocytów 1:1:1. Poziom hemoglobiny musi wynosić co najmniej 7 g/dl, fibrynogenu 150 mg/dl i trombocytów 100 tys/ml. Ogranicza do 700 ml przetoczenie crystaloidów i sztucznych coloidów w przypadku, gdy nie przeprowadzono hemostazy, uzupełnianie poziomu wapnia, stabilizacja złamanych kości, podac antybiotyk o szerokim spektrum, przetransportować pacjenta do szpitala wyszego poziomu
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