多发伤的诊疗进展
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摘要
多发伤作为急诊的常见危急重症,并发症多且发生率高,已成为当前人类死亡的主要原因之一。随着院前院内一体化救治模式的开展、损伤控制理念的提出及使用,多发伤的救治成功率大大提高。针对致死三联征的进一步研究为多发伤的救治提供了相应的理论和实践基础,限制性液体复苏和允许性低血压等新观念在临床上应用为多发伤患者的抢救争取了宝贵的时间。目前在致死三联征的防治和液体复苏方案仍存在差异,同时我国多发伤死亡率仍居高不下,因此提高多发伤的救治水平是急诊医师面临的艰巨任务。
Multiple traumas are common and severe cases in emergencies,with many complications and high incidence.It is one of the main causes of human death. With the development of integrated pre-hospital and intra-hospital treatment model,and the proposal and use of the concept of damage control,the rescue success rate of multiple traumas has been greatly improved. Further research on the lethal triad provides a theoretical and practical basis for the treatment of multiple traumas. New concepts such as restrictive fluid resuscitation and permissive hypotension have been used in clinic to gain valuable time for the rescue of patients with multiple injuries. At present,there are still differences in the prevention and treatment of lethal triad and the liquid resuscitation schemes,and the mortality rate of multiple traumas remains high in China,so improving the rescue level is the arduous task for the emergency physicians.
Multiple traumas are common and severe cases in emergencies,with many complications and high incidence.It is one of the main causes of human death. With the development of integrated pre-hospital and intra-hospital treatment model,and the proposal and use of the concept of damage control,the rescue success rate of multiple traumas has been greatly improved. Further research on the lethal triad provides a theoretical and practical basis for the treatment of multiple traumas. New concepts such as restrictive fluid resuscitation and permissive hypotension have been used in clinic to gain valuable time for the rescue of patients with multiple injuries. At present,there are still differences in the prevention and treatment of lethal triad and the liquid resuscitation schemes,and the mortality rate of multiple traumas remains high in China,so improving the rescue level is the arduous task for the emergency physicians.
引文
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[3]张连阳,黄显凯,姚元章,等.多发伤病历与诊断:专家共识意见[J].创伤外科杂志,2014,16(2):192-193.
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[5]郭飞飞,吕召旺,周子超.重症多发伤救治研究进展[J].人民军医,2016,59(4):403-405.
[6]管向东,聂垚.休克治疗的理念与进展[J/OL].中华重症医学电子杂志(网络版),2015,1(1):53-57.
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[8]丁威威,朱维铭.创伤出血性休克治疗进展[J].中国实用外科杂志,2018,38(1):87-89.
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[10]Baker CC,Oppenheimer L,Stephens B,et al.Epidemiology of trauma deaths[J].Am J Surg,1980,140(1):144-150.
[11]Rhee P,Joseph B,Pandit V,et al.Increasing trauma deaths in the United States[J].Ann Surg,2014,260(1):13-21.
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[15]Schweigkofler U,Hoffmann R.Preclinical treatment of multiple trauma:What is important?[J].Chirurg,2013,84(9):739-744.
[16]Mathis S,Kellermann S.Modified Mc Peek score in multiple trauma patients:Prospective evaluation of a points system for recording follow-up factors[J].Anaesthesist,2014,63(5):387-393.
[17]Roden-Foreman JW,Rapier NR.Asking a better question:Development and evaluation of the Need For Trauma Intervention(NFTI)metric as a novel indicator of major trauma[J].J Trauma Nurs,2017,24(3):150-157.
[18]蒋世荣,王瑜.严重多发伤救治模式的研究进展[J].医学综述,2017,23(20):4075-4078.
[19]张琦,蔡瑜,尚卫华,等.多发伤救治体系与损伤控制外科理论在救治严重多发伤患者中的应用[J].中国急救复苏与灾害医学杂志,2014,9(3):211-213.
[20]Mattu A.Damage control:Advances in trauma resuscitation[J].Emerg Med Clin North Am,2018,36(1):15-16.
[21]齐伟,于学忠.多发伤的治疗进展[J].中国急救医学,2010,30(3):208-211.
[22]Sagraves SG,Toschlog EA,Rotondo MF.Damage control surgerythe intensivist's role[J].J Intensive Care Med,2006,21(1):5-16.
[23]黄显凯.问题1:死亡三联症与损害控制外科的相互关系?[J].创伤外科杂志,2014(1),16(1):78.
[24]田勇.急性创伤性凝血病的影响因素及临床意义[D].石家庄:河北医科大学,2015.
[25]Rossaint R,Bouillon B,Cerny V,et al.The European guideline on management of major bleeding and coagulopathy following trauma:Fourth edition[J].Crit Care,2016,20:100.
[26]Theusinger OM,Stein P,Spahn DR.Transfusion strategy in multiple trauma patients[J].Curr Opin Crit Care,2014,20(6):646-655.
[27]Abdel-Aziz H,Dunham CM,Malik RJ,et al.Timing for deep vein thrombosis chemoprophylaxis in traumatic brain injury:An evidence-based review[J].Crit Care,2015,19:96.
[28]Spahn DR,Bouillon B.Management of bleeding and coagulopathy following major trauma:An updated European guideline[J].Crit Care,2013,17(2):R76.
[29]李辉,陈少军,唐朝晖.多发伤患者低体温、酸中毒及凝血功能障碍临床研究[J].中华急诊医学杂志,2015,24(3):310-314.
[30]俞康龙,陆健.创伤性凝血病的早期干预[J].临床误诊误治,2013,26(7):6-9.
[31]金娴,惠小平.创伤性休克复苏治疗的新进展[J].现代实用医学,2005,17(5):316.
[32]覃炳军,曾晖,范彦琦,等.小容量负荷主动脉时间速度积分变异率在严重多发伤休克患者液体复苏中的应用[J].广东医学,2017,38(3):430-433.
[33]Stern SA.Low-volume fluid resuscitation for presumed hemorrhagic shock:Helpful or harmful?[J].Curr Opin Crit Care,2001,7(6):422-430.
[34]Palmer L.Fluid management in patients with trauma:Restrictive versus liberal approach[J].Vet Clin North Am Small Anim Pract,2017,47(2):397-410.
[35]邓建军.限制性液体复苏对ICU多发伤休克患者复苏质量及安全性分析[J].中国实用医刊,2017,44(16):42-45.
[36]包福祥,戴守勇,顾东明,等.控制性液体复苏治疗严重多发伤的疗效及其对血清炎症因子水平的影响[J].现代生物医学进展,2014,14(5):930-932.
[37]Pfeifer R,Pape HC.Diagnostics and treatment strategies for multiple trauma patients[J].Chirurg,2016,87(2):165-173.
[38]Hwabejire JO,Imam AM,Jin G,et al.Differential effects of fresh frozen plasma and normal saline on secondary brain damage in a large animal model of polytrauma,hemorrhage and traumatic brain injury[J].J Trauma Acute Care Surg,2013,75(6):968-974.
[39]何鹏,周青山.强化胰岛素治疗对严重多发伤患者炎症因子水平及预后的影响[J].临床外科杂志,2015,23(2):122-124.
[40]Bedreag OH,Papurica M,Rogobete AF,et al.Using circulating miRNAs as biomarkers for the evaluation and monitoring of the mitochondrial damage in the critically ill polytrauma patients[J].Clin Lab,2016,62(8):1397-1403.
[2]Pape HC,Lefering R,Butcher N,et al.The definition of polytrauma revisited:An international consensus process and proposal of the new Berlin definition[J].J Trauma Acute Care Surg,2014,77(5):780-786.
[3]张连阳,黄显凯,姚元章,等.多发伤病历与诊断:专家共识意见[J].创伤外科杂志,2014,16(2):192-193.
[4]Banerjee M,Bouillon B,Shafizadeh S,et al.Epidemiology of extremity injuries in multiple trauma patients[J].Injury,2013,44(8):1015-1021.
[5]郭飞飞,吕召旺,周子超.重症多发伤救治研究进展[J].人民军医,2016,59(4):403-405.
[6]管向东,聂垚.休克治疗的理念与进展[J/OL].中华重症医学电子杂志(网络版),2015,1(1):53-57.
[7]蒋瑞山,赵小刚.多发伤创伤性休克的急救及其进展[J].医学临床研究,2015,32(7):1396-1398.
[8]丁威威,朱维铭.创伤出血性休克治疗进展[J].中国实用外科杂志,2018,38(1):87-89.
[9]Trunkey DD,Lim RC.Analysis of 425 consecutive trauma fatalities:An autopsy study[J].J Am Coll Emerg Phys,2002,3(6):368-371.
[10]Baker CC,Oppenheimer L,Stephens B,et al.Epidemiology of trauma deaths[J].Am J Surg,1980,140(1):144-150.
[11]Rhee P,Joseph B,Pandit V,et al.Increasing trauma deaths in the United States[J].Ann Surg,2014,260(1):13-21.
[12]Krestan CR.Herold C.Polytrauma[J].Der Radiologe,2014,54(9):859-860.
[13]王正国,张连杨,白祥军.多发伤救治学[M].北京:人民军医出版社,2010:100-101.
[14]Pfeifer R,Teuben M,Andruszkow H,et al.Mortality patterns in patients with multiple trauma:A systematic review of autopsy studies[J].PLo S One,2016,11(2):e0148844.
[15]Schweigkofler U,Hoffmann R.Preclinical treatment of multiple trauma:What is important?[J].Chirurg,2013,84(9):739-744.
[16]Mathis S,Kellermann S.Modified Mc Peek score in multiple trauma patients:Prospective evaluation of a points system for recording follow-up factors[J].Anaesthesist,2014,63(5):387-393.
[17]Roden-Foreman JW,Rapier NR.Asking a better question:Development and evaluation of the Need For Trauma Intervention(NFTI)metric as a novel indicator of major trauma[J].J Trauma Nurs,2017,24(3):150-157.
[18]蒋世荣,王瑜.严重多发伤救治模式的研究进展[J].医学综述,2017,23(20):4075-4078.
[19]张琦,蔡瑜,尚卫华,等.多发伤救治体系与损伤控制外科理论在救治严重多发伤患者中的应用[J].中国急救复苏与灾害医学杂志,2014,9(3):211-213.
[20]Mattu A.Damage control:Advances in trauma resuscitation[J].Emerg Med Clin North Am,2018,36(1):15-16.
[21]齐伟,于学忠.多发伤的治疗进展[J].中国急救医学,2010,30(3):208-211.
[22]Sagraves SG,Toschlog EA,Rotondo MF.Damage control surgerythe intensivist's role[J].J Intensive Care Med,2006,21(1):5-16.
[23]黄显凯.问题1:死亡三联症与损害控制外科的相互关系?[J].创伤外科杂志,2014(1),16(1):78.
[24]田勇.急性创伤性凝血病的影响因素及临床意义[D].石家庄:河北医科大学,2015.
[25]Rossaint R,Bouillon B,Cerny V,et al.The European guideline on management of major bleeding and coagulopathy following trauma:Fourth edition[J].Crit Care,2016,20:100.
[26]Theusinger OM,Stein P,Spahn DR.Transfusion strategy in multiple trauma patients[J].Curr Opin Crit Care,2014,20(6):646-655.
[27]Abdel-Aziz H,Dunham CM,Malik RJ,et al.Timing for deep vein thrombosis chemoprophylaxis in traumatic brain injury:An evidence-based review[J].Crit Care,2015,19:96.
[28]Spahn DR,Bouillon B.Management of bleeding and coagulopathy following major trauma:An updated European guideline[J].Crit Care,2013,17(2):R76.
[29]李辉,陈少军,唐朝晖.多发伤患者低体温、酸中毒及凝血功能障碍临床研究[J].中华急诊医学杂志,2015,24(3):310-314.
[30]俞康龙,陆健.创伤性凝血病的早期干预[J].临床误诊误治,2013,26(7):6-9.
[31]金娴,惠小平.创伤性休克复苏治疗的新进展[J].现代实用医学,2005,17(5):316.
[32]覃炳军,曾晖,范彦琦,等.小容量负荷主动脉时间速度积分变异率在严重多发伤休克患者液体复苏中的应用[J].广东医学,2017,38(3):430-433.
[33]Stern SA.Low-volume fluid resuscitation for presumed hemorrhagic shock:Helpful or harmful?[J].Curr Opin Crit Care,2001,7(6):422-430.
[34]Palmer L.Fluid management in patients with trauma:Restrictive versus liberal approach[J].Vet Clin North Am Small Anim Pract,2017,47(2):397-410.
[35]邓建军.限制性液体复苏对ICU多发伤休克患者复苏质量及安全性分析[J].中国实用医刊,2017,44(16):42-45.
[36]包福祥,戴守勇,顾东明,等.控制性液体复苏治疗严重多发伤的疗效及其对血清炎症因子水平的影响[J].现代生物医学进展,2014,14(5):930-932.
[37]Pfeifer R,Pape HC.Diagnostics and treatment strategies for multiple trauma patients[J].Chirurg,2016,87(2):165-173.
[38]Hwabejire JO,Imam AM,Jin G,et al.Differential effects of fresh frozen plasma and normal saline on secondary brain damage in a large animal model of polytrauma,hemorrhage and traumatic brain injury[J].J Trauma Acute Care Surg,2013,75(6):968-974.
[39]何鹏,周青山.强化胰岛素治疗对严重多发伤患者炎症因子水平及预后的影响[J].临床外科杂志,2015,23(2):122-124.
[40]Bedreag OH,Papurica M,Rogobete AF,et al.Using circulating miRNAs as biomarkers for the evaluation and monitoring of the mitochondrial damage in the critically ill polytrauma patients[J].Clin Lab,2016,62(8):1397-1403.