损伤控制性复苏用于创伤失血性休克患者围手术期管理1例

Application of damage control resuscitation for perioperative management of traumatic hemorrhagic shock:One case report

失血性休克是创伤患者主要死亡原因之一,损伤控制性复苏(damage control resuscitation,DCR)已成为首选复苏方式,补充丢失和消耗的凝血因子是复苏的关键.DCR通过早期输注血液制品首先解决创伤休克患者凝血功能障碍,同时限制晶体液的输注.核心包括允许性低血压复苏、止血性复苏、损伤控制性手术(damage control surgery,DCS),及时纠正酸中毒,加强低钙血症、高钾血症的管理,预防低体温.该病例为严重左下肢创伤致股动脉、股静脉完全断裂失血性休克患者,入院后立即识别并启动DCR,早期干预纠正凝血功能障碍、维持内环境稳定、预防低体温,在允许性低血压复苏下成功完成DCS.

Hemorrhagic shock is one of the main causes of death in trauma patients,and damage control resuscitation(DCR)has become the first choice of resuscitation.Replenishing lost and depleted clotting factors is the key to resuscitation.DCR first addresses coagulation dysfunction in patients with traumatic shock by early infusion of blood products,while limiting crystallographic infusion.Its theoretical core includes permissive hypotensive resuscitation,hemostatic resuscitation,damage control surgery(DCS),timely correction of metabolic acidosis,strengthening management of hypocalcemia and hyperkalemia,and prevention of hypothermia.This case was a hemorrhagic shock patient with complete rupture of femoral artery and femoral vein due to severe left lower limb trauma.Immediately after admission,the patient was correctly identified and DCR was initiated.Early intervention was performed to correct coagulation dysfunction,maintain internal environment stability,prevent hypothermia,and successfully completed DCS under permissive hypotensive resuscitation.