Догоспитальная помощь по принципам Damage Control Resuscitation в условиях современных боевых действий (обзор литературы)

Актуальность. Кровотечение и геморрагический шок являются основной причиной потенциально предотвратимых смертей у пострадавших в боевых действиях. Концепция догоспитального контроля повреждений Remote Damage Control Resuscitation (DCR) становится неотъемлемой частью оказания помощи раненым с шоком в полевых условиях. Значимость оказания догоспитальной помощи по принципам DCR повышается в будущих войнах, которые могут проходить одновременно на суше, море, в воздухе, космосе и киберпространстве.

Цель - рассмотреть эффективность и особенности оказания догоспитальной помощи по принципам DCR в вооруженных конфликтах последних двух десятилетий (в Афганистане, Ираке, Африке, на Ближнем Востоке).

Методология. Проведен поиск научных статей в базе данных PubMed и Научной электронной библиотеки (eLIBRARY.ru), опубликованных с 2017 по 2022 г.

Результаты и их анализ. Догоспитальная помощь по принципам DCR включает временную остановку кровотечения, инфузионную терапию в рамках гемостатической реанимации и управляемой гипотензии, адекватную респираторную поддержку, предотвращение и устранение гипотермии, скорейшую эвакуацию на этап оказания хирургической помощи. Эффективными средствами для остановки кровотечения в боевых условиях являются современные кровоостанавливающие турникеты, тазовый бандаж, гемостатические повязки с коалином и хитозаном. Перспективным методом остановки внутреннего кровотечения признана реанимационная эндоваскулярная баллонная окклюзия аорты. Основой гемостатической реанимации на поле боя становится раннее переливание крови или ее компонентов в сочетании с введением транексамовой кислоты и препаратов кальция. Цельная кровь 0 (I) группы с низким титром анти-A- и анти-В-антител, лиофилизированная плазма и концентрат фибриногена обладают логистическими преимуществами для применения в боевых условиях.

Заключение. Догоспитальная помощь по принципам DCR эффективна и позволяет значимо уменьшить летальность среди пострадавших в боевых действиях.

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