多创伤患者:当前的概念和不断变化的护理
Christopher Lee1, Todd E Rasmussen2, Hans-Christoph Pape3
1Department of Orthopaedic Surgery, University of California - Los Angeles, Los Angeles, CA.
概括
创伤护理的进步改善了多创伤患者的治疗结果. 控制出血和及时干预的新策略,如复苏性血管内气球关闭大动脉 (REBOA),提高生存率并减少并发症.
科学领域:
- 创伤外科 手术 创伤外科
- 紧急医疗 紧急医疗
- 手术创新 在外科创新.
背景情况:
- 出血仍然是急性创伤死亡的主要原因.
- 对于严重创伤的传统治疗方法也有局限性.
- 随着医疗技术的发展,需要对多创伤患者的护理原则进行更新.
研究的目的:
- 审查当前多创伤患者护理方面的进展.
- 突出出出血流控制和复苏的新兴策略.
- 讨论干预的最佳时间和新的治疗选择.
主要方法:
- 对外血管和内血管出血控制方式的审查.
- 讨论主动脉复苏性内血管气球闭塞 (REBOA) 以及其并发症.
- 探索用于指导复苏和静脉血栓塞栓症风险评估的血小板造影 (TEG).
- 对软组织缺陷的负压伤口治疗 (NPWT) 的评估.
主要成果:
- 外血管装置改善了医院前的干出血管理.
- 瑞波阿已在改善缩血压方面显示出好处,但存在风险.
- TEG提供个性化的复苏指导,并识别有风险发生静脉血栓栓塞的患者.
- NPWT是管理开放性伤口和软组织创伤的有价值的辅助.
结论:
- 最佳的多创伤患者护理整合了技术进步和生理理解.
- 及时干预,避免骨折护理的不必要延迟,至关重要.
- 个性化复苏策略和先进的伤口治疗是改善结果的关键.
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