骨盆骨折大出血救治技术与流程

由于骨盆的特殊结构,其内侧的血管网损伤导致不可压迫性出血。即使创伤中心和救治体系的建设,以及损害控制技术等发展,病死率仍然高达30%~60%。损害控制性复苏、骨盆带、外固定支架、复苏性腹主动脉内球囊阻断(REBOA)、动脉栓塞和腹膜外填塞等技术不断发展,部分已经得到普及,但迄今仍没有公认的确定性止血流程。我国正在普遍建设创伤中心,亟待制订适合我国的骨盆骨折大出血患者的救治流程,以提高救治成功率。本文阐述控制骨盆骨折大出血的外科技术和流程进展供同道参考。

Progress in management of massive hemorrhage in pelvic fracture:technique and algorithm

Due to the special structure of the pelvis,damage to the inner vascular network can lead to noncompressible bleeding. Even with the development of trauma centers and treatment systems,as well as damage control technologies,the death rate is still as high as 30% to 60%. Techniques such as injury-controlled resuscitation,pelvic bander,external fixation,Resuscitative Endovascular Balloon Occlusion of the Aorta( REBOA),arterial embolization and extraperitoneal packing have been developed and some have been popularized,but there is still no recognized definitive hemostasis procedure. China is currently building trauma centers,and it is urgent to formulate treatment procedures suitable for patients with pelvic fractures and massive bleeding in China,so as to improve the success rate of treatment. This paper describes the surgical techniques and algorithm for controlling massive hemorrhage in pelvic fractures.