Abstract
Major trauma is a frequent cause of death, and is the leading cause of death in the younger agegroups. Severe bleeding is often responsible for early mortality. The background of the latter is the trauma-induced coagulopathy (TIC), which - often very early - develops after the onset of bleeding. The high amount of blood products, i.e., massive transfusion administered during the management of traumatic bleeding can result in severe, even fatal complications. Modern, aggressive management of masssive traumatic bleeding is effective in reducing exsanguination and mortality or late complications. This method also fits into the concept of Patient Blood Management. This review deals with the up-to-date, goal-directed, preventive management of traumatic bleeding and coagulopathy, with emphasis on theoretical grounds. The aim is to present the essence of this management method also to those who are not directly involved in this activity. Orv Hetil. 2020; 161(37): 1599-1605.
Highlights
A súlyos trauma/politraumatizáció a halálozás gyakori oka, a fiatal korosztályban pedig a vezető halálozási ok
Major trauma is a frequent cause of death, and is the leading cause of death in the younger agegroups
Severe bleeding is often responsible for early mortality
Summary
Ennek hátterében a vérzés megindulását követően, sokszor már korán kialakuló, a vérzést tovább fokozó traumás véralvadási zavar (TIC: trauma-induced coagulopathy) áll. APTI = aktivált parciális tromboplasztinidő; CT = (clotting time) véralvadási idő; EXTEM = az extrinszik alvadási mechanizmus vizsgálatára szolgáló viszkoelasztikus, betegágy melletti teszt; FC = faktorkoncentrátum; FFP = friss fagyasztott plazma; FIBTEM = a fibrinogénszint vizsgálatára szolgáló viszkoelasztikus, betegágy melletti teszt; FVII = a VII-es alvadási faktor; FXIII = a XIII-as alvadási faktor; GDCT = (goal-directed coagulation treatment) célirányos alvadáskezelés; Hb = hemoglobin; INR = (international normalized ratio) nemzetközi normalizált ráta; MTP = masszív transzfúziós protokoll; PBM = (Patient Blood Management) hazai adaptációja a Nemzeti Véradó és Vérmentő Program; PCC = protrombinkomplexkoncentrátum; POCT = (point-of-care test) műtőasztal/betegágy melletti teszt; PT = protrombinidő; rFVIIa = a VII-es számú rekombináns aktivált alvadási faktor; ROTEM = (rotational thromboelastometry) rotációs tromboelasztometria; SCT = standard koagulációs teszt; TASH = (trauma-associated severe haemorrhage) traumához kapcsolódó súlyos vérzés; TI =.
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