smpСкорая медицинская помощьEMERGENCY MEDICAL CARE2072-6716Northwest State Medical University named after II Mechnikov10.24884/2072-6716-2021-22-3-71-78smp-503Research ArticleСТАТЬИARTICLESОсобенности инфузионной терапии на догоспитальном этапе при продолжающемся кровотеченииFeatures of the infusion therapy at the prehospital stage with the ongoing bleedingЩеголевА. В.ShchegolevA. V.

Щеголев Алексей Валерьянович — доктор медицинских наук, профессор, начальник кафедры военной анестезиологии и реаниматологии

194044, Санкт-Петербург, ул. Боткинская, д. 2

Aleksey V. Shchegolev

St. Petersburg

alekseischegolev@gmail.comГрицайА. Н.GricajA. N.

Грицай Александр Николаевич — кандидат медицинских наук старший преподаватель кафедры военной анестезиологии и реаниматологии

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6;

Aleksey N. Gricaj

St. Petersburg

Alexander.nik71@gmail.comКлимовА. Г.KlimovA. G.

Климов Алексей Григорьевич — доктор медицинских наук, доцент кафедры военной анестезиологии и реаниматологии

194044, Санкт-Петербург, ул. Боткинская, д. 2

Aleksandr G. Klimov

St. Petersburg

alexklim1957@mail.ruЛапшинВ. Н.LapshinV. N.

Лапшин Владимир Николаевич — доктор медицинских наук, профессор, руководитель отдела анестезиологии и реаниматологии

192242, Санкт-Петербург, Будапештская ул., д. 3

Vladimir N. Lapshin

St. Petersburg

АфончиковВ. С.AfonchikovV. S.

Афончиков Вячеслав Сергеевич — кандидат медицинских наук, доцент, нач. мед. по анестезиологии и реаниматологии

192242, Санкт-Петербург, Будапештская ул., д. 3

Vyacheslav S. Afonchikov

St. Petersburg

hwalbe262@mail.ruШустровВ. В.ShustrovV. V.

Шустров Вячеслав Владимирович — старший ординатор кафедры военной анестезиологии и реаниматологии

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Vyacheslav V. Shustrov

St. Petersburg

shustrov@anesthvmeda.ruСтруковЕ. Ю.StrukovЕ. U.

Струков Егор Юрьевич — доктор медицинских наук, доцент кафедры военной анестезиологии и реаниматологии

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Еgor U. Strukov

St. Petersburg

Военно-медицинская академия им. С. М. КироваРоссияKirov Military Medical AcademyRussian FederationСанкт-Петербургский научно-исследовательский институт скорой медицинской помощи им. И. И. Джанелидзе; Военно-медицинская академия им. С. М. КироваРоссияSt. Petersburg Dzhanelidze Research Institute of Emergency Care; Kirov Military Medical AcademyRussian FederationСанкт-Петербургский научно-исследовательский институт скорой медицинской помощи им. И. И. ДжанелидзеРоссияSt. Petersburg Dzhanelidze Research Institute of Emergency CareRussian Federation2021300920212237178Copyright © Щеголев А.В., Грицай А.Н., Климов А.Г., Лапшин В.Н., Афончиков В.С., Шустров В.В., Струков Е.Ю., 20212021Щеголев А.В., Грицай А.Н., Климов А.Г., Лапшин В.Н., Афончиков В.С., Шустров В.В., Струков Е.Ю.Shchegolev A.V., Gricaj A.N., Klimov A.G., Lapshin V.N., Afonchikov V.S., Shustrov V.V., Strukov Е.U.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://smp.spb.ru/jour/article/view/503

Обзор литературы, посвященный догоспитальной диагностике и экстренной помощи при продолжающемся неконтролируемом кровотечении, актуален в связи с особенностями тактики и характера инфузионной терапии в зависимости от тяжести кровопотери, отсроченности и продолжительности транспортировки. В работе сформулированы принципы проведения инфузионной терапии, показана эффективность изоосмолярных кристаллоидных растворов в условиях гипотензии, характерной для кровопотери. Показано, что концепция допустимой гипотензии — оптимальный подход к проведению инфузионной терапии при подозрении на продолжающееся кровотечение. По литературным данным и на основании многолетнего собственного опыта оказания экстренной помощи больным и пострадавшим при острой кровопотере представлены практические рекомендации по проведению инфузионной терапии, обеспечению и поддержанию венозного доступа при короткой, длительной и отсроченной эвакуации пострадавших с подозрением на продолжающееся кровотечение.

The article covers the principles of holding the infusion therapy at the prehospital stage with the ongoing uncontrolled bleeding. The scientific work shows the effectiveness of isoosmolar crystalloid solutions in conditions of low capillary pressure, which is typical for blood loss. The article shows that the concept of an acceptable hypotension is the most optimal approach to the infusion therapy if the ongoing bleeding is suspected in peacetime as well as in combat conditions. Recommendations are given for ensuring and maintaining venous access during short, long and delayed evacuation of victims with the suspected ongoing bleeding.

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The authors declare that there are no conflicts of interest present.