臨床外科71巻11号

2016年10月発行

増刊号 消化器・一般外科医のための—救急・集中治療のすべて

Ⅱ章 外傷外科 総論

外傷急性期凝固障害に対するdamage control resuscitationと“damage control strategy”

著者： 久志本成樹¹² 小林道生³ 吉田良太朗² 横川裕大²

所属機関： ¹東北大学大学院医学系研究科外科病態学講座救急医学分野 ²東北大学病院救急科・高度救命救急センター ³石巻赤十字病院

ページ範囲：P.133 - P.141

文献概要

■はじめに
　外傷患者の急性期死亡原因の約40%は出血によるものであり，大量輸血を要する症例の死亡率は50%を超える^1）．一方，外傷による死亡の少なくとも10%は防ぐことができた可能性があり，その15%は早期の凝固異常に関連したものである^2〜4）．
　大量出血を伴う外傷患者の治療では，主要な出血源を外科手術などによってコントロールできないことではなく，凝固異常を中心とした生理学的恒常性破綻によって出血を制御できないことにより生命を失うことのほうが多い^5,6）．出血による死亡の50%以上は凝固線溶破綻によるものであり^6,7），急性期凝固異常の制御は重症外傷治療における中心的なテーマである^8）．

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