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1、外傷與大量輸血外傷與大量輸血 高雄榮民醫院心臟外科高雄榮民醫院心臟外科 主治醫師吳東和主治醫師吳東和Massive transfusion Define:Replacement of one blood volume in 24 hTransfusion of 4 or more red cell concentrates/1 h.,ongoing Replacement of 50%of total blood volume /3h.Etiologic for massive transfusion:blood loss Trauma elective surgery disease(GI
2、bleeding,DAA rupture,.)Complication of after massive transfusion:the onset of coagulopathy.blood products have changed,affected the management of the bleeding patients.The main differences between elective surgery(ES)and trauma(T)1.tissue trauma elective surgery control trauma uncontrolThe main diff
3、erences between elective surgery(ES)and trauma(T)2.initiation of massive tranfusionelective surgery ,no delay trauma,delay The main differences between elective surgery(ES)and trauma(T)3.volume status elective surgery,normovolemia trauma,hypovolemiaThe main differences between elective surgery(ES)an
4、d trauma(T)4.shock statuselective surgery,avoided trauma,frequent The main differences between elective surgery(ES)and trauma(T)5.temperature elective surgery,normothermia trauma,hypothermia The main differences between elective surgery(ES)and trauma(T)6.monitoring of haemostasis elective surgery,on
5、going trauma,late The main differences between elective surgery(ES)and trauma(T)7.coagulopathyelective surgery,decreased coagulation factorstrauma,disseminated intravascular coagulation(DIC)The main differences between elective surgery(ES)and trauma(T)8.treatment of coagulopathyelective surgery,FFP
6、then plateletstrauma,correction of tissue hopoperfusion,hypothermia,anemia,platelets first.The main differences between elective surgery(ES)and trauma(T)9.microvascular bleeding elective surgery,late event trauma,severely.The blood products have changed:transfusion strategiesetiologic of blood loss/
7、patient condition(CADARDS)blood loss caused the deficiency of prothrombin,factor V,platelets,and factors VII.monitoring PT,APTT,fibrinogen,thrombocytopenia.FFP first for elective surgery,platelets first to trauma patient.Transfusion strategies:which blood product is better?patient condition etiologi
8、c of blood loss(CPB?)volume of blood losscorrect acidosis/hypothermia.FFP first for elective surgery,platelets first to trauma patient.Disseminated intravascular coagulation(DIC)acquired syndrome.intravascular activation of coagulation,loss of localizationoriginate from and cause damage to microvascularTrauma&DICTwo major mechamismnature of tissue traumashock and tissue hypoxiaLife threatening coagulopathya pH of 7.10temperature of 25a systolic blood pressure of 37C,extremities Hct between 32%to 36%platelet.100000./l evaluate Multiple organic function.