创伤性凝血病的诊断和监测

Diagnosis and monitoring of trauma-induced coagulopathy

创伤性凝血病(TIC)是严重创伤大失血进展为早期复杂的凝血功能紊乱。目前TIC的诊断没有统一标准,然而在严重TIC早期,机体不能有效止血而导致弥漫性微血管出血,不得不对患者实施生命支持治疗。与先天性单因子缺乏造成的出血紊乱不同,TIC凝血功能紊乱是多因素导致的,血液中所有凝血成分(包括凝血酶原激活物以及抗凝、纤溶和抗纤溶成分等)出现了不同程度的不足。TIC患者入住急诊科后大失血持续,成分输血和多器官功能不全的发生增多,与止血完善的患者相比病死率增加4倍。因此在24 h内进行早期止血和纠正休克的低灌注至关重要,在整个临床治疗过程中贯穿了低凝到高凝和TIC晚期可能发生血栓并发症危险的考量。

Trauma-induced coagulopathy(TIC)is a complex hemostatic disturbance that could develop early after a major injury.There is no universally accepted definition of TIC.However,TIC primarily refers to the inability to achieve sufficient hemostasis in patients with severely injured trauma,resulting in diffuse microvascular and life support treatment must be implemented for patients.Unlike congenital bleeding disorder which is due mostly to a single factor deficiency,coagulopathy encountered in trauma and major surgery is of a multifactorial nature.All elements in coagulation,including procoagulant,anticoagulant,fibrinolytic and antifibrinolytic proteins,exhibit various degrees of deficiency.After admission to the emergency department,the patients with TIC experienced continuous major bleeding,increased incidence of component transfusion and multiple organ dysfunction,and a four fold increase in mortality compared to patients with complete hemostasis.Therefore,early hemostasis and correction of shock hypoperfusion within 24 hours are crucial,and considerations of the risk of thrombotic complications from low coagulation to high coagulation and advanced TIC are integrated throughout the entire clinical treatment process.