Понятие «реанимационный контроль повреждений»: scoping-обзор литературы

Актуальность. Возрастает значимость реанимационного контроля повреждений (РКП) в условиях политравмы и массивного кровотечения, что представляет собой одну из основных проблем современного здравоохранения Российской Федерации. За последние 3 года наблюдается рост числа травм и их последствий, требующих комплексного подхода к ведению пациентов в реанимационной практике.

Цель работы. Оценить структуру актуальной литературы по теме «реанимационный контроль повреждений» и провести качественный анализ публикаций по её направлениям.

Материал и методы. Представлен предварительный scoping-обзор исследований за 5 лет, посвящённых применению реанимационного контроля повреждений у пациентов с политравмой. Обзор выполнен в соответствии с принципами PRISMA-ScR. Поиск проводился в электронных базах данных: Pubmed, Cochrane, Google scholar, eLIBRARY, UpToDate и CyberLeninka.

Результаты. В ходе исследования было найдено 309 статей, 82 из которых соответствовали критериям включения. Из них 30 публикаций содержали все необходимые для извлечения данные, а в 52 изучался какой-либо один компонент РКП. Больше половины источников представлены литературными обзорами (n=29) и ретроспективными исследованиями (n=20). Наиболее изучаемыми вопросами РКП стали: травмаиндуцированная коагулопатия (n=15), массивная гемотрансфузия (n=13) и организация догоспитального этапа (n=13).

Выводы. «Реанимационный контроль повреждений» — перспективная концепция интенсивной терапии травматического шока, которая объединила в себе массивную гемотрансфузию, малообъёмную инфузионную терапию, коррекцию гипотермии и гипокальциемии, а также особый догоспитальный этап, включающий респираторную поддержку, раннее введение транексамовой кислоты и компонентов крови. В совокупности с современными подходами в виде вязкоэластичных методов диагностики гемостаза и эндоваскулярных способов остановки кровотечений, а также наличием квалифицированных специалистов, оказание помощи пациентам с политравмой стало более эффективным, однако ряд частных вопросов нуждается в проведении дополнительных исследований.

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