开放期刊系统

血浆在高原移居人群创伤失血性休克复苏中的早期高比例应用

王 海莹, 张 进进, 刘 容涛, 刘 小星, 黄 永莉, 邢颜 超*

摘要

目的 探讨高原地区(4500m)移居人群创伤失血性休克患者抢救过程中早期高比例使用新鲜冰冻血浆的临床效果及应用潜力。方法 通过对高原地区移居人群血流特点和创伤失血性休克患者疾病发展特点分析,结合临床实际救治难点及相关研究进展,探讨新鲜冰冻血浆在高原移居人群创伤失血性休克中的早期应用。结果 高原移居人群与平原地区人群在血液流变方面具有较大差异,创伤失血性休克患者进行积极合理的液体复苏是完成外科手术抢救的前提,在高原地区及时进行新鲜冰冻血浆输注,可以预防过多晶体液输注造成的损害,同时有效的纠正患者凝血功能紊乱转态,并且发挥保护内皮细胞糖萼层的作用,从而维持血管通透性,降低创伤失血患者肺水肿和脑水肿的发生率,为患者后送或后期治疗提供了有力支撑。结论 高原地区移居人群创伤失血性休克患者救治与平原地区存在一定差异性,在紧急抢救条件下根据患者病情进行新鲜冰冻血浆早期高比例输注,可减少晶体液的输注,并维持甚至恢复糖萼的完整性,是一种应高度优先考虑的治疗策略。

关键词

新鲜冰冻血浆;高原;创伤失血;休克;凝血;内皮糖萼

全文:

PDF

参考

[1]Siebenmann C, Roche J, Schlittler M, et al. Regulation of haemoglobin concentration at high altitude[J]. J Physiol,2024,602(21):5587-5600.

[2]谷冬梅,刘杰,王海英.青藏地区不同海拔驻地男官兵血常规四项变化分析[J].中国药物与临床,2021,21(10):1773-1774.

GU D M, LIU J, WANG H Y. Analysis of four changes of blood routine of male soldiers at different altitudes in Qinghai-Tibet region[J].Chinese Remedies & Clinics,2021,21(10):1773-1774.

[3]Wang Z, Liu H, Dou M, et al. The quality changes in fresh frozen plasma of the blood donors at high altitude[J]. PLoS One,2017,12(4):e0176390.

[4]阿旺晋美,黄永红,宋俊等.高原创伤失血性休克液体复苏及进展[J].西藏医药杂志,2013,35(3):27-29.

[5]SPINELLA P C, HOLCOMB J B. Resuscitation and transfusion principles for traumatic hemorrhagic shock[J].Blood Rev,2009,23(6):231-40.

[6]Sun J, Tian Y, Jiang RC, et al. Study on the difference of blood coagulation function in patients with traumatic brain injury in plain and plateau area[J]. Zhonghua Yi Xue Za Zhi,2016,96(39):3125-3128.

[7]Buzzard L, Schreiber M. Trauma-induced coagulopathy: What you need to know[J].J Trauma Acute Care Surg,2024,96(2):179-185.

[8]Saviano A, Perotti C, Zanza C, et al. Blood Transfusion for Major Trauma in Emergency Department[J].Diagnostics (Basel),2024,14(7):708.

[9]Shah A, Kerner V, Stanworth SJ, et al. Major haemorrhage: past, present and future[J]. Anaesthesia,2023,78(1):93-104.

[10]高明,周虎,郭瑁,等.《欧洲创伤性严重出血和凝血病管理指南(第6版)》解读[J].中国输血杂志,2024,37(03):357-368.

[11]Lee MA, Park H, Yu B, et al. Implementation of a massive transfusion protocol: A single trauma center experience from South Korea[J]. Ulus Travma Acil Cerrahi Derg,2022,28(10):1412-1418.

[12]Dirks J, Jørgensen H, Jensen CH, et al. Blood product ratio in acute traumatic coagulopathy--effect on mortality in a Scandinavian level 1 trauma centre[J]. Scand J Trauma Resusc Emerg Med,2010,18:65.

[13]van Veelen MJ, Brodmann Maeder M. Hypothermia in Trauma[J]. Int J Environ Res Public Health,2021,18(16):8719.

[14]O'Hare N, Millican K, Ebong EE. Unraveling neurovascular mysteries: the role of endothelial glycocalyx dysfunction in Alzheimer's disease pathogenesis[J]. Front Physiol,2024,15:1394725.

[15]orres LN, Chung KK, Salgado CL, et al. Low-volume resuscitation with normal saline is associated with microvascular endothelial dysfunction after hemorrhage in rats, compared to colloids and balanced crystalloids[J].Crit Care,2017,21(1):160.

[16]Torres Filho I, Torres LN, Sondeen JL, et al. In vivo evaluation of venular glycocalyx during hemorrhagic shock in rats using intravital microscopy[J]. Microvasc Res,2013,85:128-33.

[17]Schucht JE, Matheson PJ, Harbrecht BG, et al. Plasma resuscitation with adjunctive peritoneal resuscitation reduces ischemia-induced intestinal barrier breakdown following hemorrhagic shock[J].J Trauma Acute Care Surg, 2021,90(1):27-34.

[18]Barelli S, Alberio L. The Role of Plasma Transfusion in Massive Bleeding: Protecting the Endothelial Glycocalyx?[J]. Front Med (Lausanne),2018,5:91.

[19]Smith JW, Schucht JE, Harbrecht BG, et al. Effect of Plasma Resuscitation with Adjunctive Peritoneal Resuscitation on Hepatic Blood Flow and End-Organ Damage after Hemorrhagic Shock[J].J Am Coll Surg 2022,235(4):643-653.

[20]Schechtman DW, Kauvar DS, De Guzman R, et al. Differing Resuscitation With Aortic Occlusion in a Swine Junctional Hemorrhage Polytrauma Model[J].J Surg Res,2020,248:90-97.


(0 摘要 Views, 0 PDF Downloads)

Refbacks

  • 当前没有refback。