2026-05-20
2026 TCCC指南 檔案 PDF英文版共17頁
填塞止血用的紗布. 可選擇添加止血劑成分的.
CoTCCC-recommended hemostatic gauze for massive inguinal (groin) hemorrhage wound packing.
(such as QuikClot Combat Gauze, Celox Gauze, or ChitoGauze)
2014年修訂版
Management of External Hemorrhage in Tactical Combat Casualty Care: Chitosan-Based Hemostatic Gauze Dressings--TCCC Guidelines-Change 13-05
戰術戰鬥傷亡救護中外出血的處理：殼聚醣基止血紗布敷料－TCCC指南－修訂版13-05
CoTCCC 美國戰術戰傷救護委員會. 屬於美國國防衛生局 Defense Health Agency (DHA)
簡介
出血仍然是戰鬥死亡的主要原因，也是原本可能存活的傷者死亡的主要原因之一。雖然使用止血帶控制四肢出血取得了長足進步，但並非所有傷勢都適合使用止血帶。局部止血劑和敷料也對控制四肢和可壓迫性交界處出血起到了重要作用，隨著改良產品的研發，其療效也不斷提高。自2008年4月將Combat Gauze™（Z-Medica公司，美國康乃狄克州沃靈福德；http://www.z-medica.com/）納入戰術戰鬥傷亡救護（TCCC）指南以來，動物研究對嚴重出血的持續數據表明，專為戰場應用而開發的殼聚醣基止血紗布™至少與Combatze Gau眼敷料。在民間醫院的外科手術病例報告和院前（戰場）病例報告及系列研究中，使用新型殼聚醣基敷料也取得了成功。此外，在這些病例中，以及多年來在軍方和民用院前急救領域使用殼聚醣基止血敷料的記錄中，均未發現任何併發症或安全隱患。因此，經過十年的臨床應用，使用殼聚醣基紗布敷料具有顯著的益處和良好的安全性。基於這些原因，許多美國特種作戰部隊、北約成員國軍隊以及緊急醫療服務（EMS）和執法機構已經廣泛應用這些新型推薦的殼聚醣基止血敷料。根據以往戰場上的成功經驗，本報告建議繼續將 Combat Gauze 作為首選止血敷料，同時在 TCCC 指南中新增 Celox™ Gauze（Medtrade Products Ltd.，英國克魯；http://www.celoxmedical.com/usa/products/celox-gauze/）和 ChitoGauze®（HemCon Technologies，美國俄勒岡州波特蘭市）。
Abstract
Hemorrhage remains the leading cause of combat death and a major cause of death from potentially survivable injuries. Great strides have been made in controlling extremity hemorrhage with tourniquets, but not all injuries are amenable to tourniquet application. Topical hemostatic agents and dressings have also contributed to success in controlling extremity and compressible junctional hemorrhage, and their efficacy continues to increase as enhanced products are developed. Since the addition of Combat Gauze™ (Z-Medica Corporation, Wallingford, CT, USA; http://www.z-medica.com/) in April 2008 to the Tactical Combat Casualty Care (TCCC) Guidelines, there are consistent data from animal studies of severe hemorrhage that chitosan-based hemostatic gauze dressings developed for battlefield application are, at least, equally efficacious as Combat Gauze. Successful outcomes are also reported using newer chitosan-based dressings in civilian hospital-based surgical case reports and prehospital (battlefield) case reports and series. Additionally, there have been no noted complications or safety concerns in these cases or across many years of chitosan-based hemostatic dressing use in both the military and civilian prehospital sectors. Consequently, after a decade of clinical use, there is added benefit and a good safety record for using chitosan-based gauze dressings. For these reasons, many specific US military Special Operations Forces, NATO militaries, and emergency medical services (EMS) and law enforcement agencies have already implemented the widespread use of these new recommended chitosan-based hemostatic dressings. Based on the past battlefield success, this report proposes to keep Combat Gauze as the hemostatic dressing of choice along with the new addition of Celox™ Gauze (Medtrade Products Ltd., Crewe, UK; http://www.celoxmedical.com/usa/products /celox-gauze/) and ChitoGauze® (HemCon Medical Technologies, Portland, OR, USA; http://www.hemcon.com/) to the TCCC Guidelines.
另一篇相關筆記.
到院前止血-傷口填塞 Wound Packing Essentials (針對EMT救護員)
2025-07-11 15:45
傷口填塞一般使用於比較深且不容易止血的傷口. 不建議使用於頸部, 胸部, 腹部.
還有一種止血法, 稱為 Preperitoneal pelvic packing, 用於外傷導致骨盆骨折合併嚴重出血, 無法以其他方式有效止血時. 醫師在手術中將紗布填塞於病患骨盆腔(腹膜之外)
Preperitoneal Packing for Pelvic Fracture Bleeding Control:
上圖來自 Thr trauma pro
下面資料來自 uptodate-Control of external hemorrhage in trauma patients
僅節錄傷口填塞這段.
以下中文使用google翻譯
傷口填塞可填充任何死腔區域，並增加對傷口深層血管的直接壓力[ 18 ]。
填塞創傷性傷口時，應將乾淨的布、紗布或含止血劑的敷料深深地、牢固地壓入傷口。在保持直接壓力的同時，應繼續填塞直至傷口填滿。填塞完成後，塗抹敷料覆蓋傷口，並用雙手施加壓力。然後，應保持該壓力直至止血[ 18 ]。
市售的含止血劑敷料包括因子濃縮劑、黏膜黏附劑和促凝血劑。這些敷料可用於施加直接壓力並填塞傷口。放置這些敷料後，應施加至少3分鐘的直接壓力[ 19,20 ]。需要注意的是，某些敷料可能含有不透射線的標記，這可能會導致CT成像出現散射。 (請參閱“局部止血劑和組織黏合劑的概述”，關於‘外用藥物’一節)
Wound packing — Wound packing fills any area of dead space and increases direct pressure on the vessels deep within the wound [18].
To pack a traumatic wound, a clean cloth, gauze, or hemostatic-impregnated dressing is pressed deeply and firmly into the wound. While maintaining direct pressure, packing should be added until the wound is filled. Once packed, the wound should be covered with a dressing, and pressure should be applied using two hands. Then, it should be maintained until hemostasis is achieved [18].
Factor concentrators, mucoadhesives, and procoagulants are options for commercially available hemostatic-impregnated dressings. These dressings can be used to apply direct pressure and pack a wound. At least three minutes of direct pressure should be applied after placing these dressings [19,20]. Note that some dressings may have a radiopaque marker that can cause scatter on computed tomographic (CT) imaging. (See "Overview of topical hemostatic agents and tissue adhesives", section on 'External agents'.)
