大量输血治疗方案
原作者： Feras Khan, 葛赟译, 肖锋校 文章来源： 《中华急诊医学杂志》编辑部 发布日期：2015-01-25

 Title: Massive Transfusion Protocols

题目：大量输血治疗方案

Author 作者: Feras Khan

翻译：葛赟 校对：肖锋

 

 

 

What is a massive transfusion?

什么是大量输血？

• Can be institution dependent but usually means greater than 10 Units of blood products transfused within 24hrs.

• 根据医疗单位不同，但通常定义为24小时内输入＞10单位的血制品

• Most hospitals have this as a protocol that a physician can order to notify the blood bank that a large volume of blood products may be required rapidly.

• 大部分医院的治疗方案是医生报告血库，需要紧急快速的大量血制品。

 

When would I use this?

我们什么时候使用它？

Indications 适应症:

-Systolic Blood pressure < 100

收缩压＜100mmHg

-Unable to obtain blood pressure

测不到血压

AND 和

-Penetrating torso trauma

躯干穿透伤

-Positive FAST

FAST阳性发现

-External blood loss

体外血液丢失

-Plans to go to the OR

计划进手术室

 

How do I give it?

我们如何使用？

1 The transfusion ratio is usually 1:1:1 or 2:1:1

2 输血比例通常为1:1:1或2:1:1

3 Give 1 unit PRBC, then 1 U FFP, and alternate until 6 units of each have been given and then 1 bag of apheresis platelets (6 equivalent units). Can repeat as needed.

4 给予1单位红细胞，1单位新鲜冰冻血浆，交替直到6单位，然后给予1袋血小板（6单位），按照需要，重复给予

 

Does this apply for just traumatic bleeding?

这一方案只用于外伤出血吗？

• Although this data was based on soldiers in the recent Iraq Wars, it has been used for medical patients as well.

• 尽管这些数据是来源于最近伊拉克战争的士兵，但是它同样适用于普通患者。

• Therefore, consider using in upper GI bleeds, post-partum hemorrhage, etc.

• 因此，考虑可使用在上消化道出血，产后出血等。

 

Are there other agents I can use?

我们可以使用另外的药物吗？

• There is some data to give tranexamic acid early (less than three hours from injury) in trauma patients who are hypotensive and are having severe bleeding.

• 一些数据提出可对低血压和严重出血的外伤患者早期（外伤3小时内）给予氨甲环酸

 

What am I trying to do with this protocol?

在应用这个方案的同时，我还应试图做什么？

• Control hemorrhage

• 控制出血

• Use the best products possible

• 使用最好的产品

• Prevent hypothermia

• 预防低体温

• Prevent hemodilution

• 预防血液稀释

• Treat coagulopathy

• 治疗高凝状态

 

References 参考文献：

Murthi SB, Stansbury LG, Dutton RP, et al. TRAnsfusion medicine in trauma patients: an update. Expert Rev Hematol. 2011 Oct;4(5):527-37.

Hess JR, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008 Oct; 65(4):748-54.

University of Maryland SHOCK Trauma Massive Transfusion Protocol. 2011.