面对大出血打印遭遇战题库.ppt

会不会有DIC？ Effects of Hemodilution on Coagulation Factors Bolliger D, I，et al. Br J Anaesth 2010; 104: 318–25. Systemic hypoperfusion drive acute coagulopathy - anticoagulation Brohi et al. Current Opinion in Critical Care 2007, 13:680–685 Systemic hypoperfusion drive acute coagulopathy - Hyperfibrinolysis Brohi et al. Current Opinion in Critical Care 2007, 13:680–685 Changes in thrombin-generation kinetics after hypothermia- and acidosis-induced in pigs Martini WZ, et al. J Trauma. 2005;58:1002–1009; discussion 1009–1010. Fibrin Polymerization and Fibrinolysis Bolliger D, I，et al. Br J Anaesth 2010; 104: 318–25. RBC:FFP:Plt Massive Transfusion Protocols， MTPs RBC：FFP：Plt = 1:1:1 Brian P. McGlinch. Anesthesia for Trauma Emergency Surgery. In: John F. Butterworth IV, David C. Mackey, John D. Wasnick. Morgan Mikhail’s Clinical Anesthesiology. 5th ed. New York: McGraw-Hill Education, 2013:87-122. 30% 100% 200% 300% 400% 500% 术毕 2.4 1.8 1.5 1.6 1.6 2.1 1.6 aPTT 1.5 1.4 1.5 1.7 2.3 2.1 1.8 PT 1 1.4 2.3 1.5 1.6 0.9 2.2 Fib 82 78 85 90 68 88 110 Hb FFP 或 冷沉淀 109 79 59 50 41 30 44 PLT 冷沉淀 RBC:FFP 【 2:1 】【3:1】 RBC 血小板 TXA: 10mg/kg, 1mg/kg/h 小 结 团队的力量 外科压迫，减慢出血 多个静脉通道，快速输液 好钢用在刀刃上 凝血功能障碍 最终结局； 病人出院 万汶6250ml，晶体4500ml RBC 3000ml（15U） ，FFP 3000ml（15u） 总输液量17750ml， 失血量14000ml, 尿量1200ml 感谢聆听! The surgeon’s fingers on the aortic pulse can provide useful information regarding volume status: a soft , compressible aorta represents profound hypovolemia, whereas a firm, pulsatile aorta suggests more normal volume status. * 1. 先打好静脉，肝素帽封好。 没有人想故意大出血。 * 晶体自由通透。 * * * ” “ ” “ 面对大出血打赢遭遇战 昆明医科大学第二附属医院麻醉科 思永玉 90 13 14 15 16 17 18 ABP 23/12mmHg，无波形，HR 120-130bpm，最需要做什么？ 腹腔镜右半肝切除术 失血量 600 500 700 1100 快速输液 - 一人负责一个静脉通道 外科医师用纱布按压减少出血的速度 输液＞出血 Slowing hemorrhage The surgeon will usually compress or pack the area of bleeding if the patient is hypotensive, an intervention that usually improves hemodynamics by slowing hemorrhage and allowing more rapid restoration of circulating blood volum