شواهد نقد شده در زمینه مدیریت اولیه بيماران دچار مولتیپل تروما با خونريزي شدید در بخش اورژانس؛ یک مطالعه مروری نظام مند

مصطفی علوی مقدم, مجید شجاعی, سعید قناعت پیشه
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دیده شده


چکیده

مقدمه: خونریزی شدید ناشی از تروما در صورت عدم تشخیص و عدم درمان صحیح و به هنگام پیامدهای ناگواری در پی خواهد داشت. در مطالعه حاضر در مورد شواهد نقد شده در زمینه توصيه هاي درماني اولیه در بيماران ترومايي دچار خونريزي شدید در اورژانس در قالب یک مطالعه مروری نظام مند پرداخته شد. روش کار:اين مطالعهاز نوع مروري نظام مند در مورد شواهد نقد شده در زمینه توصيه هاي درماني اولیه در بيماران مولتیپل ترومايي دچار خونريزي شدید در اورژانس بود. پس از نوشتن PICO برای سوال های بالینی مطالعه، جستجو برای یافتن مقاله های اصیل در پایگاه های Tripdatabase،PubMed, Cochrane  ،Google Scholar  محدود به زبان انگليسي و در محدوده زمانی2000  تا 2018 و با استفاده از کلمات کليدي Multiple Trauma، Hemorrhage، Emergency ، Therapy، صورت گرفت. در این مطالعه برای بررسی کیفی مقالات از فلوچارت پریزما استفاده گردید. شواهد به دست آمده بر اساس سطح بندی آکسفورد طبقه بندی شدند. نتایج: از میان 502 مقاله حاصل از جستجو در پایگاه های اطلاعاتی ، 44 مقاله با توجه به معیارهای پژوهش، جهت ارزیابی نهایی انتخاب شدند. نتایج مطالعات مورد بررسی ، اثرات مطلوب به کارگیری  احیای محدود مایعات  با رویکرد هیپوتانسیون، استفاده از تورنيكت، انتقال خون زودهنگام، تجویز ترانس آمین و فاکتورهای انعقادی (فیبرینوژن و فاکتور 7) در  بیماران ترومايي دچار خونريزي شدید در اورژانس با شرایط خاص را نشان داد.نتیجه گیری: بر اساس این مطالعه مروری نظام مند، به کارگیری  احیای محدود مایعات  با رویکرد هیپوتانسیون، تورنيكت، ترانس آمین، انتقال خون زودهنگام، ترانس آمین و فاکتورهای انعقادی (فیبرینوژن و فاکتور 7)در بيماران مولتیپل ترومايي با شرایط خاص دچار خونريزي توصیه می شوند.

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DOI: https://doi.org/10.22037/ijem.v7i1.26843

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