Pathophysiology of Trauma-Induced Coagulopathy and Management of Critical Bleeding Requiring Massive Transfusion
Pathophysiology of Trauma-Induced Coagulopathy and Management of Critical Bleeding Requiring Massive Transfusion
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DOI：
10.1055/s-0035-1564831
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发表时间：
2016-03-01
影响因子：
5.7
通讯作者：
Hayakawa, Mineji
中科院分区：
文献类型：
--
作者：
Gando, Satoshi;Hayakawa, Mineji
外伤性凝血障碍是由多种因素引起的，如贫血、血液稀释、体温过低、酸中毒、休克和严重创伤本身，由于严重出血需要大量输血而影响患者的预后。创伤和/或创伤性休克直接引起的弥漫性血管内凝血(DIC)具有纤溶表型，被认为是创伤性凝血障碍的主要病理生理机制。控制DIC的关键是积极治疗潜在的疾病，即创伤本身和失血性休克。损伤控制复苏包括损伤控制手术、允许性降压和止血复苏，其目的是控制严重创伤和严重出血，这相当于处理DIC的潜在疾病。然而，目前缺乏基于证据的损害控制复苏实践。将具有纤溶表型的弥漫性血管内凝血(DIC)作为影响患者预后的创伤所致凝血障碍的主要病理条件，进行损伤控制复苏的前瞻性结果研究，对于改进治疗策略至关重要。
Trauma-induced coagulopathy is caused by multiple factors, such as anemia, hemodilution, hypothermia, acidosis, shock, and serious trauma itself, which affects patient outcomes due to critical bleeding requiring massive transfusion. Disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype directly caused by trauma and/or traumatic shock has been considered to be the primary pathophysiology of trauma-induced coagulopathy. The key to controlling DIC is vigorous treatment of the underlying disorder, that is, trauma itself and hemorrhagic shock. Damage control resuscitation, consisting of damage control surgery, permissive hypotension, and hemostatic resuscitation, aims to control severe trauma and critical bleeding, which is equivalent to managing the underlying disorder of DIC. At present, however, evidence-based practices for damage control resuscitation are lacking. A robust prospective outcome study for damage control resuscitation that considers DIC with the fibrinolytic phenotype as the main pathological condition of trauma-induced coagulopathy affecting patient outcome is essential for improving therapeutic strategies.