RÉSUMÉ
During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
RÉSUMÉ
Objective To evaluate the efficacy and safety of early anticoagulation therapy using low-molecular-weight heparin sodium against venous thromboembolism (VTE) in traumatic patients.Methods A total of 120 severely traumatized patients were assigned to convention group (n =60) and anticoagulation group (n =60) according to the random number table.Patients in convention group were given physical therapy against VTE,while in anticoagulation group were given add-on low-molecularweight heparin sodium against VTE once the stopping of blood bleeding was achieved.Safety parameters were recorded including VTE incidence,blood loss indexes,hemorrhage-related complications,incidence of heparin-induced thrombopenia (HIT) and blood coagulation function indicators.Results Thirteen patients presented with VTE,with 10 patients (17％) in convention group versus 3 patients 5％) in anticoagulation group (P ＜ 0.05).Blood loss index in convention group was 1.252 ± 1.033 versus 1.447 ± 1.196 in anticoagulation group;two patients (3％) developed gastrointestinal bleeding in convention group versus five patients (8％) in anticoagulation group;five patients (8％) had wound bleeding in convention group versus eight patients (13％) in anticoagulation group (all P ＞ 0.05).HIT was not noted in anticoagulation group.At the endpoint of evaluation,no significant differences were noted between the two groups with regard to changes in prothrombin time (PT),activated partial thromboplastin time (APTT) and D-dimers (P ＞ 0.05);however,convention group versus anticoagulation group showed significant differences in international normalized ratio (INR) (0.97 ± 0.10 vs.1.03 ±0.17),fibrin (Fib) [(4.85-± 1.37) g/L vs.(4.01 ± 1.16) g/L] and platelet (PLT) [(317.68 ±141.71) ×109/Lvs.(422.20±178.16) ×109/L] (P＜0.05).Conclusion Inthe earlystage of trauma,low-molecular-weight heparin anticoagulation therapy can significantly reduce the incidence of VTE without increasing the risk of bleeding.