The coagulopathy of trauma versus disseminated intravascular coagulation
The coagulopathy of trauma versus disseminated intravascular coagulation
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DOI：
10.1097/01.ta.0000199545.06536.22
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发表时间：
2006-06-01
影响因子：
--
通讯作者：
Lawson, JH
中科院分区：
文献类型：
--
作者：
Hess, JR;Lawson, JH
创伤凝血障碍是一种非手术的黏膜病变、浆膜表面、伤口和血管通路部位出血的综合征，与严重损伤、低温、酸中毒、血液稀释有关，偶尔还伴有典型的弥漫性血管内凝血(DIC)。这在很大程度上可以由寒冷对血小板功能的影响，pH对凝血因子活性的影响，以及复苏液和常规血液制品的稀释效应来解释。DIC在创伤后急性发生，此时脑、脂肪、羊水或其他强凝血活酶进入血液循环。当内皮细胞炎症或衰竭导致激活的凝血因子清除减少，微血栓导致继发性损伤时，就会亚急性发生。在大量输血的情况下，应预见创伤的凝血障碍。早期使用血浆治疗可以延缓其发病。潜在的机制应该通过实验室测试来确认。
The coagulopathy of trauma is a syndrome of non-surgical bleeding from mucosal lesions, serosal surfaces, and wound and vascular access sites associated with serious injury, hypothermia, acidosis, hemodilution, and occasionally with classic disseminated intravascular coagulation (DIC). It can be largely explained by the effects of cold on platelet function, the effect of pH on coagulation factor activity, and the dilutional effects of resuscitation fluids and conventional blood products. DIC occurs acutely after trauma when brain, fat, amniotic fluid, or other strong thromboplastins enter the circulation. It occurs subacutely when endothelial inflammation or failure reduces clearing of activated coagulation factors allowing microthrombi to cause secondary injury. The coagulopathy of trauma should be anticipated in massive transfusion situations. Early treatment with plasma can delay its onset. The underlying mechanisms should be confirmed with laboratory testing.