颅脑创伤急性期凝血功能障碍诊治专家共识(2024版)

Expert consensus on the diagnosis and treatment of coagulation disorders in the acute phase of traumatic brain injury(version 2024)

颅脑创伤急性期凝血功能障碍高发,显著增加颅内进展性出血及术中大出血风险、救治难度及患者病死率。颅脑创伤后大量组织因子暴露导致凝血异常激活是颅脑创伤急性期凝血功能障碍的主要病理机制,是一种特殊类型的创伤性凝血病。目前,颅脑创伤急性期凝血功能障碍起病隐匿、出现时往往不合并大出血、诊断标准不一、诊治不规范,尚缺乏相关共识或指南。为此,国家创伤医学中心颅脑创伤专业委员会和中国医师协会神经外科医师分会神经重症专家委员会组织国内相关专家,参考国内外相关领域最新指南、共识和临床研究,通过改良德尔菲法征集专家建议,共同制订《颅脑创伤急性期凝血功能障碍诊治专家共识(2024版)》,就颅脑创伤急性期凝血功能障碍的诊断与治疗提出18条推荐意见,旨在规范临床诊治。

The high incidence of coagulation disorders in the acute phase after traumatic brain injury significantly increases the risks of progressive intracranial hemorrhage and massive intraoperative bleeding,the difficulty of treatment and the mortality rate of the patients.The main pathological mechanism for coagulation disorders in the acute phase after traumatic brain injury is that a large number of tissue factors become exposed to result in an aberrant activation of coagulation,so it is a special type of trauma-induced coagulopathy.Coagulation disorder in the acute phase after traumatic brain injury has an insidious onset that is often not associated with massive bleeding,leading to non-standardized diagnosis and treatment.Currently,there is a lack of relevant consensus or guideline.For this purpose,Neurotrauma Committee of the National Trauma Center and Neurocritical Care Expert Committee of Branch of Neurological Surgeons of Chinese Medical Doctor Association have organized relevant domestic experts to jointly formulate Expert consensus on the diagnosis and treatment of coagulation disorders in the acute phase of traumatic brain injury(version 2024)with reference to the latest guidelines,consensuses,and clinical researches in relevant fields at home and abroad and expert advice collected through the modified Delphi method.Eighteen recommendations have been proposed for the diagnosis and treatment of coagulation disorders in the acute phase of traumatic brain injury,aiming to standardize its diagnosis and treatment in the clinical settings.