摘要
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.
作者
袁强
虞剑
陈建
陈文劲
丁天凌
方文华
冯军峰
高国一
高亮
杭春华
贺晓生
胡荣
胡颖红
黄齐兵
江荣才
蓝胜勇
李立宏
李育
刘劲芳
马驰原
马辉
毛青
帕珠
任学芳
石广志
苏作鹏
苏忠周
孙晓川
王玉海
王中
魏俊吉
徐福林
许汪斌
张立平
张云东
周建新
王之敏
周强
陈菊祥
李强
冯光
孙晓欧
孙成法
王加充
吕胜青
侯立军
杜倬婴
吴刚
胡锦
国家创伤医学中心颅脑创伤专业委员会
中国医师协会神经外科医师分会神经重症专家委员会
Yuan Qiang;Yu Jian;Chen Jian;Chen Wenjin;Ding Tianling;Fang Wenhua;Feng Junfeng;Gao Guoyi;Cao Liang;Hang Chunhua;He Xiosheng;Hu Rong;Hu Yinghong;Huang Qibing;Jiang Rongcai;Lan Shengyong;Li Lihong;Li Yu;Liu Jinfang;Ma Chiyuan;Ma Hui;Mao Qing;Pa Zhu;Ren Xuefang;Shi Cuangzhi;Su Zuopeng;Su Zhongzhou;Sun Xiaochuan;Wang Yuhai;Wang Zhong;Wei Junji;Xu Fulin;Xu Wangbin;Zhang Liping;Zhang Yundong;Zhou Jianxin;Wang Zhimin;Zhou Qiang;Chen Juxiang;Li Qiang;Feng Guang;Sun Xiaoou;Sun Chengfa;Wang Jiachong;Lyu Shengqing;Hou Lijun;Du Zhuoying;Wu Gang;Hu Jin;Neurotrauma Committee of the National Trauma Center;Neurocritical Care Expert Committee of Branch of Neurological Surgeons of Chinese Medical Doctor Association(Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Affiliated Hospital of Nantong University,Nantong 226006,China;Xuanwu Hospital of Capital Medical University,Beijing 100053,China;First Affiliated Hospital of Fujian Medical University,Fuzhou 350004,China;Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Beijing Tiantan Hospital of Capital Medical University,Beijing 100050,China;Affiliated Tenth People's Hospital of Tongji University,Shanghai 200072,China;Nanjing Drum Tower Hospital Affiliated to Nanjing University School of Medicine,Nanjing 210008,China;Xijing Hospital of Air Force Medical University,Xi'an 710032,China;First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Qilu Hospital of Shandong University,Jinan 250063,China;Tianjin Medical University General Hospital,Tianjin 300052,China;Guangxi Zhuang Autonomous Region People's Hospital,Nanning 530021,China;Tangdu Hospital of Air Force Medical University,Xi'an 710038,China;Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830001,China;Xiangya Hospital of Central South University,Changsha 410008,China;General Hospital of Eastern Theater Command of PLA,Nanjing 210007,China;Ningxia Medical University General Hospital,Yinchuan 750003,China;Shigatse People's Hospital of Xizang Autonomous Region,Shigatse 857012,China;Minhang Hospital Affliated to Fudan University,Shanghai 201199,China;Huzhou Central Hospital,Huzhou 313099,China;First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;th Hospital of Joint Logistic Support Force of PLA,Wuxi 214004,China;First Affiliated Hospital of Soochow University,Suzhou 215006,China;Peking Union Medical College Hospital,Bejing 100730,China;First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Second Hospital of Lanzhou University,Lanzhou 730030,China;Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Bejing Century Temple Hospital Affliated to Capital Medical University,Bejing 10089,China;Suzhou Dushu Lake Hospital,Suzhou 215004,China;Suzhou Jiulong Hospital,Suzhou 215127,China;First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Henan Provincial People's Hospital,Zhengzhou 450003,China;Affiliated Changshu Hospital of Nantong University,Changshu 215513,China;Haikou People's Hospital,Haikou 570208,China;Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Second Affiliated Hospital of Naval Medical University,Shanghai 200070,China;不详)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2024年第4期310-322,共13页
Chinese Journal of Trauma
基金
上海申康医院发展中心市级医院诊疗技术推广及优化管理项目(SHDC22023224,SHDC22022210)
海南省院士创新平台基金(YSPTZX202033)。
关键词
脑损伤
颅内出血
创伤
凝血功能障碍
Brain injuries
Intracranial hemorrhage,traumatic
Blood coagulation disorders