Aktualne spojrzenie na masywny krwotok actual view-point for massive hemorrhage
DOI:
https://doi.org/10.15587/2313-8416.2015.42078Ключові слова:
krzepnięcia, utrata krwi, urazami wojennymi, terroryzmem, fibrynogenu, tromboelastografiaАнотація
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
Посилання
Ogura, T., Nakamura, Y., Nakano, M., Izawa, Y., Nakamura, M., Fujizuka, K. et. al. (2014). Predicting the need for massive transfusion in trauma patients. Journal of Trauma and Acute Care Surgery, 76 (5), 1243–1250. doi: 10.1097/ta.0000000000000200
Rentas, F., Lincoln, D., Harding, A., Maas, P., Giglio, J., Fryar, R. et. al. (2012). The Armed Services Blood Program. Journal of Trauma and Acute Care Surgery, 73, 472–478. doi: 10.1097/ta.0b013e31827546e4
Grottke, O. (2012). Coagulation management. Current Opinion in Critical Care, 18 (6), 641–646. doi: 10.1097/mcc.0b013e328358e254
Esmon, C. (2000). The protein C pathway. Critical Care Medicine, 28, 44–48. doi: 10.1097/00003246-200009001-00010
Cohen, M. J., Call, M., Nelson, M., Calfee, C. S., Esmon, C. T., Brohi, K., Pittet, J. F. (2012). Critical Role of Activated Protein C in Early Coagulopathy and Later Organ Failure, Infection and Death in Trauma Patients. Annals of Surgery, 255 (2), 379–385. doi: 10.1097/sla.0b013e318235d9e6
Sperry, J. L., Nathens, A. B., Frankel, H. L., Vanek, S. L., Moore, E. E., Maier, R. V., Minei, J. P. (2008). Characterization of the gender dimorphism after injury and hemorrhagic shock: Are hormonal differences responsible?*. Critical Care Medicine, 36 (6), 1838–1845. doi: 10.1097/ccm.0b013e3181760c14
Ley, E. J., Clond, M. A., Srour, M. K., Barnajian, M., Mirocha, J., Margulies, D. R., & Salim, A. (2011). Emergency Department Crystalloid Resuscitation of 1.5 L or More is Associated With Increased Mortality in Elderly and Nonelderly Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care, 70(2), 398–400. doi: 10.1097/ta.0b013e318208f99b
Trzebicki, J. i wsp. (2009). Tromboelastometria – nowa metoda wspomagającadecyzje terapeutyczne w zaburzeniach hemostazy, oparta na tromboelastografii Harteta. Polski Merkuriusz Lekarski, XXVII, 85.
Woźniak, D. i wsp. (2011). Tromboelastografia, metoda szybkiej diagnostyki zaburzeń układu krzepnięcia. Anestezjologia Intensywna Terapia, 43, 244.
Holley, A. D., Reade, M. C. (2013). The procoagulopathy of trauma: to much, too late. Current Opinion in Critical Care, 19, 578. doi: 10.1097/mcc.0000000000000032
Lier, H., Böttiger, B. W., Hinkelbein, J., Krep, H., & Bernhard, M. (2011). Coagulation management in multiple trauma: a systematic review. Intensive Care Medicine, 37(4), 572–582. doi: 10.1007/s00134-011-2139-y
Lichte, P., Kobbe, P., Dombroski, D., Pape, H. C. (2012). Damage control orthopedics: current evidence. Current Opinion in Critical Care, 18 (6), 647–650. doi: 10.1097/mcc.0b013e328359fd57
Rosenfeld, J. V. (2004). Damage control neurosurgery. Injury, 35 (7), 655–660. doi: 10.1016/j.injury.2004.03.006
Rall, J. M., Cox, J. M., Songer, A. G., Cestero, R. F., Ross, J. D. (2013). Comparison of novel hemostatic dressings with QuikClot combat gauze in a standardized swine model of uncontrolled hemorrhage. Journal of Trauma and Acute Care Surgery, 75, 150–156. doi: 10.1097/ta.0b013e318299d909
Kheirabadi, B. S., Terrazas, I. B., Hanson, M. A., Kragh, J. F., Dubick, M. A., Blackbourne, L. H. (2013). In vivo assessment of the Combat Ready Clamp to control junctional hemorrhage in swine. Journal of Trauma and Acute Care Surgery, 74 (5), 1260–1265. doi: 10.1097/ta.0b013e31828cc983
Stinger, H. K., Spinella, P. C., Perkins, J. G., Grathwohl, K. W., Salinas, J., Martini, W. Z. et. al. (2008). The Ratio of Fibrinogen to Red Cells Transfused Affects Survival in Casualties Receiving Massive Transfusions at an Army Combat Support Hospital. The Journal of Trauma: Injury, Infection, and Critical Care, 64, 79–85. doi: 10.1097/ta.0b013e318160a57b
Holcomb, J. B., Fox, E. E., Zhang, X., White, N., Wade, C. E., Cotton, B. A. et. al. (2013). Cryoprecipitate use in the PROMMTT study. Journal of Trauma and Acute Care Surgery, 75, 31–39. doi: 10.1097/ta.0b013e31828fa3ed
Wafaisade, A., Lefering, R., Maegele, M., Brockamp, T., Mutschler, M., Lendemans, S. et. al. (2013). Trauma Registry of DGU: Administration of fibrinogen concentrate in exsanguinating trauma patients is associated with improved survival at 6 hours but not at discharge. Journal of Trauma and Acute Care Surgery, 74 (2), 387–395. doi: 10.1097/ta.0b013e31827e2410
Schöchl, H., Nienaber, U., Hofer, G., Voelckel, W., Jambor, C., Scharbert, G. et. al. (2010). Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM®)-guided administration of fibrinogen concentrate and prothrombin complex concentrate. Critical Care, 14 (2), 55. doi: 10.1186/cc8948
Joseph, B., Hadjizacharia, P., Aziz, H., Kulvatunyou, N., Tang, A., Pandit, V. et. al. (2013). Prothrombin complex concentrate: an effective therapy in reversing the coagulopathy of traumatic brain injury. Journal of Trauma and Acute Care Surgery, 74 (1), 248–253. doi: 10.1097/ta.0b013e3182788a40
Joseph, B., Amini, A., Friese, R. S., Houdek, M., Hays, D., Kulvatunyou, N., Wynne, J., O'Keeffe, T., Latifi, R., Rhee, P. (2012). Factor IX complex for the correction of traumatic coagulopathy. Journal of Trauma and Acute Care Surgery, 72 (4), 828–834. doi: 10.1097/TA.0b013e318247c944
Brown, L. M., Aro, S. O., Cohen, M. J. (2011). A High Fresh Frozen Plasma: Packed Red Blood Cell Transfusion Ratio Decreases Mortality in All Massively Transfused Trauma Patients Regardless of Admission International Normalized Ratio. The Journal of Trauma: Injury, Infection, and Critical Care, 71, 358–363. doi: 10.1097/ta.0b013e318227f152
McCully, S. P., Fabricant, L. J., Kunio, N. R., Groat, T. L., Watson, K. M., Differding, J. A. et. al. (2013). The International Normalized Ratio overestimates coagulopathy in stable trauma and surgical patients. Journal of Trauma and Acute Care Surgery, 75 (6), 947–953. doi: 10.1097/ta.0b013e3182a9676c
Pidcoke, H. F., Aden, J. K., Mora, A. G., Borgman, M. A., Spinella, P. C., Dubick, M. A. et. al. (2012). Ten-year analysis of transfusion in Operation Iraqi Freedom and Operation Enduring Freedom. Journal of Trauma and Acute Care Surgery, 73, 445–452. doi: 10.1097/ta.0b013e3182754796
Holcomb, J. B., Zarzabal, L. A., Michalek, J. E., Kozar, R. A., Spinella, P. C., Perkins, J. G. et. al. (2011). Increased Platelet:RBC Ratios Are Associated With Improved Survival After Massive Transfusion. The Journal of Trauma: Injury, Infection, and Critical Care, 71, 318–328. doi: 10.1097/ta.0b013e318227edbb
Brown, L. M., Call, M. S., Margaret Knudson, M., Cohen, M. J. (2011). A Normal Platelet Count May Not Be Enough: The Impact of Admission Platelet Count on Mortality and Transfusion in Severely Injured Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care, 71, 337–342. doi: 10.1097/ta.0b013e318227f67c
Rentas, F., Lincoln, D., Harding, A., Maas, P., Giglio, J., Fryar, R. et. al. (2012). The Armed Services Blood Program. Journal of Trauma and Acute Care Surgery, 73, 472–478. doi: 10.1097/ta.0b013e31827546e4
Ho, A. M.-H., Dion, P. W., Yeung, J. H. H., Holcomb, J. B., Critchley, L. A. H., Ng, C. S. H. (2012). Prevalence of Survivor Bias in Observational Studies on Fresh Frozen Plasma. Anesthesiology, 116 (3), 716–728. doi: 10.1097/aln.0b013e318245c47b
Davenport, R., Curry, N., Manson, J., DeʼAth, H., Coates, A., Rourke, C. et. al. (2011). Hemostatic Effects of Fresh Frozen Plasma May be Maximal at Red Cell Ratios of 1:2. The Journal of Trauma: Injury, Infection, and Critical Care, 70 (1), 90–96. doi: 10.1097/ta.0b013e318202e486
Elterman, J., Brasel, K., Brown, S., Bulger, E., Christenson, J., Kerby, J. D. (2013). Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes. Journal of Trauma and Acute Care Surgery, 75 (1), 8–14. doi: 10.1097/ta.0b013e318298492e
Theusinger, O. M., Stein, P., Spahn, D. R. (2014). Transfusion strategy in multiple trauma patients. Current Opinion in Critical Care, 20 (6), 646–655. doi: 10.1097/mcc.0000000000000152
Ryan, M. L., Thorson, C. M., Otero, C. A., Vu, T., Schulman, C. I., Livingstone, A. S., Proctor, K. G. (2012). Initial hematocrit in trauma: a paradigm shift? Journal of Trauma and Acute Care Surgery, 72 (1), 54–59. doi: 10.1097/TA.0b013e31823d0f35
Rahbar, E., Fox, E. E., del Junco, D. J., Harvin, J. A., Holcomb, J. B., Wade, C. E. et. al. (2013). PROMMIT StudyGroup: Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study. Journal of Trauma and Acute Care Surgery, 75, 16–23. doi: 10.1097/ta.0b013e31828fa535
Repine, T. B., Perkins, J. G., Kauvar, D. S., Blackborne, L. (2006). The Use of Fresh Whole Blood in Massive Transfusion. The Journal of Trauma: Injury, Infection, and Critical Care, 60, 59–69. doi: 10.1097/01.ta.0000219013.64168.b2
Cotton, B. A., Harvin, J. A., Kostousouv, V., Minei, K. M., Radwan, Z. A., Schöchl, H. et. al. (2012). Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. Journal of Trauma and Acute Care Surgery, 73 (2), 365–370. doi: 10.1097/ta.0b013e31825c1234
Chapman, M. P., Moore, E. E., Ramos, C. R., Ghasabyan, A., Harr, J. N., Chin, T. L. et. al. (2013). Fibrinolysis greater than 3 % is the critical value for initiation of antifibrinolytic therapy. Journal of Trauma and Acute Care Surgery, 75 (6), 961–967. doi: 10.1097/ta.0b013e3182aa9c9f
CRASH-2 trial collaborators, Shakur H. et al.: Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial (2010). Lancet, 376, 23.
Morrison, J. J. (2012). Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Archives of Surgery, 147 (2), 113. doi: 10.1001/archsurg.2011.287
Morrison, J. J., Ross, J. D., Dubose, J. J., Jansen, J. O., Midwinter, M. J., Rasmussen, T. E. (2013). Association of Cryoprecipitate and Tranexamic Acid With Improved Survival Following Wartime Injury. JAMA Surgery, 148 (3), 218. doi: 10.1001/jamasurg.2013.764
CRASH-2 Collaborators, Intracranial Bleeding Study: Effect of tranexamic acid in traumatic brain injury: a nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study) (2011). BMJ, 343, 3795
Eckert, M. J., Wertin, T. M., Tyner, S. D., Nelson, D. W., Izenberg, S., Martin, M. J. (2014). Tranexamic acid administration to pediatric trauma patients in a combat setting. Journal of Trauma and Acute Care Surgery, 77 (6), 852–858. doi: 10.1097/ta.0000000000000443
Valle, E. J., Allen, C. J., Van Haren, R. M., Jouria, J. M., Li, H., Livingstone, A. S. et. al. (2014). Do all trauma patients benefit from tranexamic acid? Journal of Trauma and Acute Care Surgery, 76 (6), 1373–1378. doi: 10.1097/ta.0000000000000242
Theusinger, O. M. (2012). The Inhibiting Effect of Factor XIII on Hyperfibrinolysis. Anesthesia & Analgesia, 114(6), 1149–1150. doi: 10.1213/ane.0b013e318252e9f1
Dutton, R. P., McCunn, M., Hyder, M., D’Angelo, M., O’Connor, J., Hess, J. R., Scalea, T. M. (2004). Factor VIIa for Correction of Traumatic Coagulopathy. The Journal of Trauma: Injury, Infection, and Critical Care, 57 (4), 709–719. doi: 10.1097/01.ta.0000140646.66852.ab
Spinella, P. C., Perkins, J. G., McLaughlin, D. F., Niles, S. E., Grathwohl, K. W., Beekley, A. C. et. al .(2008). The Effect of Recombinant Activated Factor VII on Mortality in Combat-Related Casualties With Severe Trauma and Massive Transfusion. The Journal of Trauma: Injury, Infection, and Critical Care, 64 (2), 286–294. doi: 10.1097/ta.0b013e318162759f
Boffard, K. D., Riou, B., Warren, B., Choong, P. I. T., Rizoli, S., Rossaint, R. et. al. (2005). NovoSeven Trauma Study Group: Recombinant Factor VIIa as Adjunctive Therapy for Bleeding Control in Severely Injured Trauma Patients: Two Parallel Randomized, Placebo-Controlled, Double-Blind Clinical Trials. The Journal of Trauma: Injury, Infection, and Critical Care, 59 (1), 8–18. doi: 10.1097/01.ta.0000171453.37949.b7
Hauser, C. J., Boffard, K., Dutton, R., Bernard, G. R., Croce, M. A., Holcomb, J. B. et. al. (2010). Results of the CONTROL Trial: Efficacy and Safety of Recombinant Activated Factor VII in the Management of Refractory Traumatic Hemorrhage. The Journal of Trauma: Injury, Infection, and Critical Care, 69 (3), 489–500. doi: 10.1097/ta.0b013e3181edf36e
Cotton, B. A., Jerome, R., Collier, B. R., Khetarpal, S., Holevar, M., Tucker, B. et. al .(2009). Guidelines for Prehospital Fluid Resuscitation in the Injured Patient. The Journal of Trauma: Injury, Infection, and Critical Care, 67 (2), 389–402. doi: 10.1097/ta.0b013e3181a8b26f
Duke, M. D., Guidry, C., Guice, J., Stuke, L., Marr, A. B., Hunt, J. P. et. al. (2012). Restrictive fluid resuscitation in combination with damage control resuscitation. Journal of Trauma and Acute Care Surgery, 73 (3), 674–678. doi: 10.1097/ta.0b013e318265ce1f
Hampton, D. A., Fabricant, L. J., Differding, J., Diggs, B., Underwood, S., De La Cruz, D. et. al. (2013). Prehospital intravenous fluid is associated with increased survival in trauma patients. Journal of Trauma and Acute Care Surgery, 75, 9–15. doi: 10.1097/ta.0b013e318290cd52
Schnüriger, B., Inaba, K., Wu, T., Eberle, B. M., Belzberg, H., Demetriades, D. (2011). Crystalloids After Primary Colon Resection and Anastomosis at Initial Trauma Laparotomy: Excessive Volumes Are Associated With Anastomotic Leakage. The Journal of Trauma: Injury, Infection, and Critical Care, 70 (3), 603–610. doi: 10.1097/ta.0b013e3182092abb
Asehnoune, K., Faraoni, D., Brohi, K. (2014). What’s new in management of traumatic coagulopathy? Intensive Care Medicine, 40 (11), 1727–1730. doi: 10.1007/s00134-014-3388-3
##submission.downloads##
Опубліковано
Номер
Розділ
Ліцензія
Авторське право (c) 2015 Zbigniew Rybicki
Ця робота ліцензується відповідно до Creative Commons Attribution 4.0 International License.
Наше видання використовує положення про авторські права Creative Commons CC BY для журналів відкритого доступу.
Автори, які публікуються у цьому журналі, погоджуються з наступними умовами:
1. Автори залишають за собою право на авторство своєї роботи та передають журналу право першої публікації цієї роботи на умовах ліцензії Creative Commons CC BY, котра дозволяє іншим особам вільно розповсюджувати опубліковану роботу з обов'язковим посиланням на авторів оригінальної роботи та першу публікацію роботи у цьому журналі.
2. Автори мають право укладати самостійні додаткові угоди щодо неексклюзивного розповсюдження роботи у тому вигляді, в якому вона була опублікована цим журналом (наприклад, розміщувати роботу в електронному сховищі установи або публікувати у складі монографії), за умови збереження посилання на першу публікацію роботи у цьому журналі.
