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结合指南和国内的实际情况,救治创伤性休克的重点是组织器官的灌注,提高其救治率关键在于尽早去除休克病因,同时尽早恢复有效的组织灌注,改善组织细胞氧供,重建氧供需平衡并恢复细胞正常功能。创伤性休克的临床复苏必须在有效、及时地评估指导下进行。评估内容包括病因的消除、有效循环血容量状态、微循环是否已改善、氧代谢状态、水电解质酸碱平衡和器官功能等,对上述指标进行动态监测和评估。组织灌注和氧代谢指标对评估休克及判断预后具有重要意义。
Abstract：Following the guidelines and considering domestic situation of traumatic care,we should keep in mind that key issue in the treatment of traumatic shock is the tissue and organ perfusion.Specially,removal of the primary cause of shock as well as effective restoration of tissue perfusion should be established as soon as possible in order to improve tissue oxygen supply and to restore normal cell functions.To accomplish this in the clinical practice,resuscitation of traumatic shock must be guided by the continuous evaluation on the following parameters: elimination of the primary causes,status of blood circulation and microcirculation,status of oxygen metabolism,status of water electrolyte and acid-base balance,and organ functions.Tissue perfusion and oxygen metabolism are the most important factors in determining the prognosis of traumatic shock.
[1]王佩燕.设立创伤急诊势在必行[J].中国医学科学院学报,2008,30(2):125-127.
[2]Maegele M,Lefering R,Yucel N,et al.Early coagulopathy in multiple injury:an analysis from the German Trauma Registry on8724 patients[J].Injury,2007,38:298-304.
[3]Bickell W H,Barrett SM,Romine-Jenkins M,et al.Resuscitation of canine hemorrhagic hypotension with large-volume isotonic crystalloid:impact on lung water,venous admixture,and systemic arterial oxygen saturation[J].The American journal of emergency medicine,1994,12(1):36-42.
[4]沈洪.创伤早期液体复苏的利弊[J].中华急诊医学杂志,2002,11(2):136-137.
[5]Timothy Craig Hardcastle,Elmin Steyn,Kenneth Boffard,et al.Guideline for the assessment of trauma centres for South Africa[J].South Africa Med J,2011,101(3):189-194.
[6]Rolf Rossaint,Bertil Bouillon,Vladimir Cerny,et al.Management of bleeding following major trauma:an updated European guideline[J].Critical Care,2010,14:R52.
[7]Cothren CC,Moore EE,Hedegaard HB,et al.Epidemiology of urban trauma deaths:a comprehensive reassessment 10 years later[J].World J Surg,2007,31:1507-1511.
[8]Cinelli SM,Brady P,Rennie CP,et al.Comparative results of trauma scoring systems in fatal outcomes[J].Conn Med,2009,73:261-265.
[9]Jackson MR,Olson DW,Beckett WC Jr,et al.Abdominal vascular trauma:a review of 106 injuries[J].Am Surg,1992,58:622-626.
[10]Gillman LM,Ball CG,Panebianco N,et al.Clinician performed resuscitative ultrasonography for the initial evaluation and resuscitation of trauma[J].Scand J Trauma Resusc Emerg Med,2009,17:34.
[11]Miller PR,Moore PS,Mansell E,et al.External fixationor arteriogram in bleeding pelvic fracture:initial therapy guided bymarkers of arterial hemorrhage[J].J Trauma,2003,54:437-443.
[12]Snyder HS.Significance of the initial spun hematocrit in trauma patients[J].Am J Emerg Med,1998,16:150-153.
[13]Abramson D,Scalea TM,Hitchcock R,et al.Lactate clearance and survival following injury[J].J Trauma,1993,35:584-588,discussion 588-589.
[14]Cothren CC,Moore EE.Emergency department thoracotomy for the critically injured patient:Objectives,indications,and outcomes[J].World JEmerg Surg,2006,1:4.
[15]Johnson JW,Gracias VH,Schwab CW,et al.Evolution in damage control for exsanguinating penetrating abdominal injury[J].J Trauma,2001,51:261-269.
[16]Eddy VA,Morris JA Jr,Cullinane DC.Hypothermia,coagulopathy,and acidosis[J].Surg Clin North Am,2000,80:845-854.
[17]Hebert PC,Wells G,Blajchman MA,et al.A multicenter,randomized,controlled clinical trial of transfusion requirements in critical care.Transfusion Requirements in Critical Care Investigators,Canadian Critical.Care Trials Group[J].N Engl J Med,1999,340:409-417.
[18]Etemadrezaie H,Baharvahdat H,Shariati Z,et al.The effect of fresh frozen plasma in severe closed head injury[J].Clin Neurol Neurosurg,2007,109:166-171.
基本信息:
DOI：10.16048/j.cnki.tccm.2013.01.011
中图分类号:R605.971
引用信息:
[1]高燕,赵雪生.创伤性休克治疗指南解读[J].创伤与急危重病医学,2013,1(01):21-24.DOI:10.16048/j.cnki.tccm.2013.01.011.
2013-10-15
2013-10-15