切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2016, Vol. 02 ›› Issue (01) : 26 -31. doi: 10.3877/cma.j.jssn.2096-1537.2016.01.007

所属专题: 重症医学 文献

专家论坛

重症创伤:重症医学有不可替代的作用
康焰1,*,*(), 唐之韵1   
  1. 1. 610041 成都,四川大学华西医院重症医学科
  • 收稿日期:2016-01-14 出版日期:2016-02-28
  • 通信作者: 康焰

Intensive care for patients with severe trauma

Yan Kang1(), Zhiyun Tang1   

  1. 1. Department of Intensive Care Unit, West China Hospitial, Sichuan University, Chengdu 610041, China
  • Received:2016-01-14 Published:2016-02-28
  • Corresponding author: Yan Kang
  • About author:
    Corresponding author: Kang Yan, Email:
引用本文:

康焰, 唐之韵. 重症创伤:重症医学有不可替代的作用[J]. 中华重症医学电子杂志, 2016, 02(01): 26-31.

Yan Kang, Zhiyun Tang. Intensive care for patients with severe trauma[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(01): 26-31.

各种不同的致伤因素作用于人体后,会出现局部组织器官损伤,同时通过神经体液的调节作用,伤者可以出现不同程度和类型的应激变化,从而体现在不同的器官功能受损上,所以伤者病情往往因此呈现多样性和复杂性表现。因此快速准确评估创伤患者的全身器官受损情况对治疗极为重要。在对伤者进行救治的过程中应当重点考虑评估伤者的器官功能情况,并在了解器官受损后的适应代偿过程的情况下,合理分析器官功能可能发生的变化过程,并据此通过限制性液体复苏、大量输血治疗和损伤控制复苏等方法进行合理有效的治疗。

Trauma to human body may lead to damage of some organs. After neurohumoral regulation, patients will present with different stress reactions, showing dysfunction of different organs. Thus, trauma patients are characterized by the complexity of clinical presentations. Efficient and precise functional evaluations of overall damages are vital for the treatment of patients. The understanding of organ function and functional reserve might help physicians to find possible changes of disease and treat patients with appropriate therapies including limited fluid resuscitation, massive transfusion, and damage control.

[1]
Champion HR, Sacco WJ, Carnazzo AJ, et al. Trauma score[J]. Crit Care Med, 1981, 9(9):672–676.
[2]
Champion HR, Sacco WJ, Copes WS, et al. A revision of the trauma score[J]. J Trauma, 1989, 29(5):623–629.
[3]
Gilpin DA, Nelson PG. Revised trauma score: A triage tool in the accident and emergency department[J]. Injury, 1991, 22(1):35–37.
[4]
Cohen R, Adini B, Radomislensky I, et al. Involvement of surgical residents in the management of trauma patients in the emergency room: does the presence of an attending physician affect outcomes?[J]. World J Surg, 2012, 36(3):539–547.
[5]
林一丹, 杨晓妍, 石应康. 修正创伤评分在急诊躯干损伤救治中的应用与改良[J] . 中国胸心血管外科临床杂志, 2013, 20(2):181–184.
[6]
Cormican SP. CRAMS scale: Field triage of trauma victims[J]. Ann Emerg Med, 1982, 11(3):132–135.
[7]
Kenneth J, Charles J, Fisher JR. The rapid acute physiology score[J]. Am J Emerg Med, 1987, 5(4):278–282.
[8]
Koehler JJ, Baer LJ, Malafa SA, et al. Pre-hospital Index: A scoring system for field triage of trauma victims[J]. Ann Emerg Med, 1986, 15(2):178–182.
[9]
Scheetz LJ, Zhang J, Kolassa JE, et al. Evaluation of injury databases as a preliminary step to developing a triage decision rule[J]. J Nurs Scholarsh, 2008, 40(2):144–150.
[10]
Kirkpatrick JR, Youmans RI. Trauma index revised: A better triage tool[J]. Critical Care Med, 1990, 18(2):174–180.
[11]
Bi DW, Wang W, Fei J, et al. Bio-mechanics research of thoracolumbar vertebral burst fracture in impact damage[J] . Zhong guo Gu Shang, 2010, 23(10):772–775.
[12]
Kane G, Engelhard R, Celentano J, et al. Empirical development and evaluation of pre-hospital trauma triage instruments[J]. J Trauma, 1985, 25(6):482–489.
[13]
Vincent JL, De Backer D. Circulatory shock[J]. N Engl J Med, 2013, 369(18):1726–1734.
[14]
Vincent JL, Rhodes A, Perel A, et al. Clinical review: update on hemodynamic monitoring - a consensus of 16. Crit Care, 2011, 15(4):229.
[15]
Vincent JL. Understanding cardiac output. Crit Care, 2008, 12(4):174.
[16]
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med, 2001, 345(19):1368–1377.
[17]
Spahn DR, Bouillon B, Cerny V, et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline[J]. Crit Care, 2013, 17(2):R76.
[18]
Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock[J]. Intensive Care Med, 2013, 39(2):165–228.
[19]
Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock[J]. Crit Care Med, 2004, 32(8):1637–1642.
[20]
Cheddie S, Muckart DJ, Hardcastle TC. Base deficit as an early marker of coagulopathy in trauma[J]. S Afr J Surg, 2013, 51(3):88–90.
[21]
Calvete JO, Schonhorst L, Moura DM, et al. Acid-base disarrangement and gastric intramucosal acidosis predict outcome from major trauma[J]. Rev Assoc Med Bras, 2008, 54(2):116–121.
[22]
Clavijo-Alvarez JA1, Sims CA, Menconi M, et al. Bladder mucosa pH and Pco2 as a minimally invasive monitor of hemorrhagic shock and resuscitation[J]. J Trauma, 2004, 57(6):1199–1209; discussion 1209–1210.
[23]
De Backer D, Hollenberg S, Boerma C, et al. How to evaluate the microcirculation: report of a round table conference. Crit Care, 2007, 11(5):R101.
[24]
Yolcu S1, Beceren GN, Tomruk Ö, et al. Can mean platelet volume levels of trauma patients predict severity of trauma?[J]. Platelets, 2014, 25(4):279–284.
[25]
Davenport R, Manson J, De’Ath H, et al. Functional definition and characterization of acute traumatic coagulopathy[J]. Crit Care Med, 2011, 39(12):2652–2658.
[26]
Moore HB, Moore EE, Chapman MP, et al. Viscoelastic measurements of platelet function, not fibrinogen function, predicts sensitivity to tissue-type plasminogen activator in trauma patients[J]. J Thromb Haemost, 2015, 13(10):1878–1887.
[27]
Inaba K1, Rizoli S, Veigas PV, et al. 2014 Consensus conference on viscoelastic test-based transfusion guidelines for early trauma resuscitation: Report of the panel[J]. J Trauma Acute Care Surg, 2015, 78(6):1220–1229.
[28]
中华医学会重症医学分会. 低血容量休克复苏指南(2007)[J]. 中国实用外科杂志, 2007, 27(8):581–587.
[29]
Leidel BA, Kirchhoff C, Bogner V, et al. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins[J]. Resuscitation, 2012, 83(1):40–45.
[30]
Nirula R, Maier R, Moore E, et al. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality[J]. J Trauma, 2010, 69:595–601.
[31]
Haas B, Nathens AB. Pro/con debate: is the scoop and run approach the best approach to trauma services organization?[J]. Crit Care, 2008, 12(5):224.
[32]
Hampton DA1, Fabricant LJ, Differding J, et al. Prehospital intravenous fluid is associated with increased survival in trauma patients[J]. J Trauma Acute Care Surg, 2013, 75(1):S9–15.
[33]
Bickell WH, 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]. Am J Emerg Med, 1994, 12(1):36–42.
[34]
Kwan I, Bunn F, Chinnock P, et al. Timing and volume of fluid administration for patients with bleeding[J]. Cochrane Database Syst Rev, 2014, 3:CD002245.
[35]
Chatrath V, Khetarpal R, Ahuja J. Fluid management in patients with trauma: Restrictive versus liberal approach[J]. J Anaesthesiol Clin Pharmacol, 2015, 31(3):308–316.
[36]
Bulger EM, May S, Kerby JD, et al. Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial[J]. Ann Surg, 2011, 253(3):431–441.
[37]
Bulger EM, Jurkovich GJ, Nathens AB, et al. Hypertonic resuscitation of hypovolemic shock after blunt trauma: a randomized controlled tria[J]. Arch Surg, 2008, 143(2):139–149.
[38]
Battison C, Andrews PJ, Graham C, et al. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury[J]. Crit Care Med, 2005, 33(1):196–202.
[39]
Cooper DJ, Myles PS, McDermott FT, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial[J]. JAMA, 2004, 291(11):1350–1357.
[40]
Bulger EM, May S, Brasel KJ, et al. Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial[J]. JAMA, 2010, 304(13):1455–1464.
[41]
Bulger EM, May S, Kerby JD, et al. Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial[J]. Ann Surg, 2011, 253(3):431–441.
[42]
Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients[J]. Cochrane Database Syst Rev, 2011, 16(3):CD000567.
[43]
James MF, Michell WL, Joubert IA, et al. Resuscitation with hydroxyethyl starch improves renal function and lactate clearance in penetrating trauma in a randomized controlled study: the FIRST trial (Fluids in Resuscitation of Severe Trauma)[J]. Br J Anaesth, 2011, 107(5):693–702.
[44]
Brunkhorst FM, Engel C, Bloos F, et al. German Competence Network Sepsis (SepNet): Intensive insulin therapy and pentastarch resuscitation in severe sepsis[J]. N Engl J Med, 2008, 358(2):125–139.
[45]
Groeneveld AB, Navickis RJ, Wilkes MM. Update on the comparative safety of colloids: a systematic review of clinical studies[J]. Ann Surg, 2011, 253(3):470–483.
[46]
Perner A, Haase N, Wetterslev J, et al. Comparing the effect of hydroxyethyl starch 130/0.4 with balanced crystalloid solution on mortality and kidney failure in patients with severe sepsis (6S-Scandinavian Starch for Severe Sepsis/Septic Shock trial): study protocol, design and rationale for a double-blinded, randomised clinical trial.[J] Trials, 2011, 12:24.
[47]
Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients [J/CD]. Cochrane Database Syst Rev. 2013, 2:CD000567.
[48]
Boldt J. Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence[J]. Can J Anaesth, 2004, 51(5):500–513.
[49]
Cooper DJ, Myburgh J, Heritier S, et al. Albumin resuscitation for traumatic brain injury: is intracranial hypertension the cause of increased mortality?[J]. J Neurotrauma, 2013, 30(7):512–518.
[50]
Schöchl H, Cotton B, Inaba K, et al. FIBTEM provides early prediction of massive transfusion in trauma[J]. Crit Care, 2011, 15(6):R265.
[51]
Hess JR, Brohi K, Dutton RP, et al. The coagulopathy of trauma: a review of mechanisms[J]. J Trauma, 2008, 65(4):748–754.
[52]
Johansson PI, Stensballe J. Hemostatic resuscitation for massive bleeding: the paradigm of plasma and platelets--a review of the current literature[J]. Transfusion, 2010, 50(3):701–710.
[53]
Zink KA, Sambasivan CN, Holcomb JB, et al. A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study[J]. Am J Surg, 2009, 197(5):565–70; discussion 570.
[54]
Holcomb JB, Zarzabal LA, Michalek JE, et al. Increased platelet:RBC ratios are associated with improved survival after massive transfusion[J]. J Trauma, 2011, 71(2 Suppl 3):S318–328.
[55]
Inaba K, Lustenberger T, Rhee P, et al. The impact of platelet transfusion in massively transfused trauma patients[J]. J Am Coll Surg, 2010, 211(5):573–579.
[56]
Johansson PI, Oliveri RS, Ostrowski SR. Hemostatic resuscitation with plasma and platelets in trauma[J]. J Emerg Trauma Shock, 2012, 5(2):120–125.
[57]
Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial[J]. JAMA, 2015, 313(5):471–482.
[58]
Ho AM, Dion PW. Reconstituted whole blood plus fibrinogen for massive transfusion in trauma[J]. Anaesthesia, 2015, 70(9):1096.
[59]
Hauser CJ, Boffard K, Dutton R, et al. Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage[J]. J Trauma, 2010, 69(3):489–500.
[60]
Ho KM, Leonard AD. Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study[J]. Anaesth Intensive Care, 2011, 39(1):46–54.
[61]
CRASH-2 trial collaborators, Shakur H, Roberts I, 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[J]. Lancet, 2010, 376(9734):23–32.
[62]
Fluckiger C, Bechir M, Brenni M, et al. Increasing hematocrit above 28% during early resuscitative phase is not associated with decreased mortality following severe traumatic brain injury[J]. Acta Neurochir (Wien), 2010, 152(4):627–636.
[63]
Yang CJ, Hsiao KY, Su IC, et al. The association between anemia and the mortality of severe traumatic brain injury in emergency department[J]. J Trauma, 2011, 71(6):E132–135.
[64]
Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy[J]. Ann Surg, 1983, 197(5):532–535.
[65]
Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma[J]. J Trauma, 2007, 62(2):307–310.
[66]
Asensio JA, McDuffie L, Petrone P, et al. Reliable variables in the exsanguinated patient which indicate damage control and predict outcome[J]. Am J Surg, 2001, 182(6):743–751.
[67]
Moore EE, Burch JM, Franciose RJ, et al. Staged physiologic restoration and damage control surgery[J]. World J Surg, 1998, 22(12):1184–1190
[68]
Hsu JM, Pham TN. Damage control in the injured patient[J]. Int J Crit Illn Inj Sci, 2011, 1(1):66–72.
[69]
Roberts DJ, Bobrovitz N, Zygun DA, et al. Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: A content analysis and expert appropriateness rating study[J]. J Trauma Acute Care Surg, 2015, 79(4):568–579.
[70]
Wall MJ Jr, Soltero E. Damage control for thoracic injuries[J]. Surg Clin North Am, 1997, 77(4):863–878.
[71]
Rosenfeld JV: Damage control neurosurgery[J]. Injury. 2004, 35(7):655–660.
[72]
Pape HC, Rixen D, Morley J, et al. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients)[J]. Ann Surg, 2007, 246(3):491–499.
[73]
Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilationinduced hypotension during cardiopulmonary resuscitation[J]. Circulation, 2004, 109(16):1960–1965.
[74]
Davis DP, Hoyt DB, Ochs M, et al. The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury[J]. J Trauma, 2003, 54(3):444–453.
[75]
Warner KJ, Cuschieri J, Copass MK, et al. Emergency department ventilation effects outcome in severe traumatic brain injury[J]. J Trauma, 2008, 64(2):341–347.
[1] 衣晓丽, 胡沙沙, 张彦. HER-2低表达对乳腺癌新辅助治疗疗效及预后的影响[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 340-346.
[2] 谭巧, 苏小涵, 侯令密, 黎君彦, 邓世山. 乳腺髓样癌的诊治进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 366-368.
[3] 米洁, 陈晨, 李佳玲, 裴海娜, 张恒博, 李飞, 李东杰. 儿童头面部外伤特点分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 511-515.
[4] 江泽莹, 王安婷, 王姣丽, 陈慈, 周秋玲, 黄燕娟, 周芳, 薛琰, 周剑烽, 谭文勇, 杜美芳. 多种植物油组分预防肿瘤放化疗相关毒性反应的效果分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 523-527.
[5] 朴广昊, 李屹洲, 刘瑞, 赵建民, 王凌峰. 皮肤撕脱伤撕脱皮瓣活力早期评估与修复的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 528-532.
[6] 张伟. 牙及牙槽外科:舒适治疗的先锋[J]. 中华口腔医学研究杂志(电子版), 2023, 17(06): 386-388.
[7] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[8] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[9] 张海涛, 康婵娟, 翟静洁. 胰管支架置入治疗急性胆源性胰腺炎效果观察[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 654-657.
[10] 杨雪, 张伟, 尚培中, 宋创业, 尚丹丹, 张蔚. 胆囊十二指肠瘘结石经瘘口排出后自愈一例报道[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 707-708.
[11] 邱朋, 邓正栋, 王剑明. 肝内胆管结石微创治疗策略[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 591-596.
[12] 杜锡林, 谭凯, 贺小军, 白亮亮, 赵瑶瑶. 肝细胞癌转化治疗方式[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 597-601.
[13] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[14] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[15] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
阅读次数
全文


摘要