创伤致死三联征课件.pptVIP

严重创伤后凝血功能障碍的早期预警 长时转运 输血15u ISS 25~35 pH 7.1~7.2 低血压 70分钟, SBp 70mmHg 体温 34~35 ℃ BE ≤ -15 “The Triad of Death”预防及治疗策略 Strategies to correct coagulopathy Reverse hypothermia and maintain an effective circulating blood volume and oxygenation Preferably use whole blood and/or the freshest available Give FFP（鲜冻血浆） to replace coagulation factors (10—15 ml/kg approx. 2 units will achieve 30% factor activity in adults) Give platelets Give cryoprecipitate(冷凝蛋白沉淀物） Strategies to correct coagulopathy Give calcium (10 mmol) to reverse hypocalacaemia Consider the use of adjuncts to promote coagulation/reduce fibrinolysis (e.g. aprotinin 抑肽酶) Consider the use of rVIIa（基因重组凝血因子Ⅶ ） Give Vitamin K Repeat coagulation tests and blood count and modify treatment accordingly ---- Michael J.A. Parr 严重创伤后凝血功能障碍的防治策略 防治原发伤：减少出血→减少休克、酸中毒、 血液稀释 恰当复苏： DCR（Damage Control Resuscitation） 1 及时纠正休克 2 允许性低血压（脑外伤除外） 3 及时识别低体温 4 及时纠正酸中毒 5 早期纠正凝血病 严重创伤后凝血功能障碍的防治策略 防治低体温 早期补充血浆、血小板、红细胞（1:1:1） 早期恰当用止血药：凝血因子Ⅶ（ rⅦa 基因重组凝血因子Ⅶ等），在各10u的PRBCs、 plt、FFP、冷凝沉淀物输注后仍出血可以给 10μg/Kg。 DIC早期可用抑肽酶、蛋白酶抑制剂 注意警惕转入高凝→形成血栓、肺栓塞等 建议End points PT、PTT1.25倍对照 血小板 100000/mm3 纤维蛋白原100 mg% ---- Judy Mikhail Strategies to correct hypothermia Warm room Room T 28.8C, may not be feasible in many ICUs Cover/insulate patient Reduces convection, conduction and radiant heat loss Prevent unnecessary exposure Strategies to correct hypothermia Dry patient Remove any wet sheets/clothing to reduce evaporative heat loss Active warming External Forced air warming device (e.g. Bair Hugger TM) Warm water blanket Radiant heaters Strategies to correct hypothermia