脓毒症诱导凝血障碍和弥散性血管内凝血的治疗进展

Progress in the treatment of sepsis induced coagulation disorders and disseminated intravascular coagulation

凝血障碍通常发生在脓毒症时,是宿主对感染的反应,可发展为弥散性血管内凝血(DIC),增加病死率。最近的研究进一步确定了导致血栓炎症反应和血管内血栓形成的因素。诊断DIC有助于脓毒症的管理,并与改善预后相关。尽管国际血栓和止血学会(ISTH)提出了诊断显性DIC的标准,但这些标准不适用于早期检测。因此,ISTH DIC科学标准化委员会提出了一个新的类别,称为“脓毒症诱导的凝血病(SIC)”,以促进DIC的早期诊断和对这些危重患者更快速的干预。SIC的治疗包括潜在感染的治疗和凝血病的纠正,大多数治疗方法集中于抗凝治疗。本文就脓毒症诱导凝血障碍和弥散性血管内凝血的治疗进展综述。

Coagulation disorders commonly occur in sepsis,as a host response to infection,and can develop into disseminated intravascular coagulation(DIC),increasing mortality rates.Recent research has further identified factors contributing to thromboinflammatory responses and intravascular thrombus formation.Diagnosis of DIC aids in the management of sepsis and is associated with improved prognosis.Although the International Society on Thrombosis and Haemostasis(ISTH)has proposed criteria for diagnosing overt DIC,these standards are not suitable for early detection.Therefore,the ISTH DIC Scientific Standardization Committee has introduced a new category termed“sepsis-induced coagulopathy(SIC)”to facilitate early diagnosis of DIC and expedite intervention for critically ill patients.Treatment for SIC involves addressing underlying infections and correcting coagulopathy,with most therapeutic approaches focusing on anticoagulation therapy.This review summarizes recent advances in the treatment of sepsis-induced coagulation disorders and DIC.