外科理论与实践 ›› 2023, Vol. 28 ›› Issue (05): 425-431.doi: 10.16139/j.1007-9610.2023.05.06
收稿日期:
2023-07-21
出版日期:
2023-09-25
发布日期:
2024-01-04
通讯作者:
朱峰
E-mail:alexzhufeng0816@vip.sina.com
基金资助:
Received:
2023-07-21
Online:
2023-09-25
Published:
2024-01-04
摘要:
创伤性凝血病的诊治是严重创伤病人救治的重要一环。创伤性凝血病有创伤性高凝血症及创伤性低凝血症两种表型。创伤病人早期的凝血功能障碍表型多变。黏弹性止血试验能反映创伤病人凝血全貌,可以指导临床医师快速识别创伤性凝血病的不同表型,并针对不同凝血指标障碍进行精细化管理。本文介绍了黏弹性止血试验常见的检测方式及其原理,并结合当前国内外文献报道,总结了不同分型下的创伤性凝血病的基于黏弹性止血试验的诊断及治疗方法,以期给广大临床医师提供临床诊治思路。
中图分类号:
沈拓, 朱峰. 黏弹性止血试验导向的创伤性凝血病诊治[J]. 外科理论与实践, 2023, 28(05): 425-431.
SHEN Tuo, ZHU Feng. Viscoelastic hemostasis assay guided diagnosis and treatment of trauma-induced coagulopathy[J]. Journal of Surgery Concepts & Practice, 2023, 28(05): 425-431.
[1] |
TISHERMAN S A, SCHMICKER R H, BRASEL K J, et al. Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the resuscitation outcomes consortium[J]. Ann Surg, 2015, 261(3):586-590.
doi: 10.1097/SLA.0000000000000837 pmid: 25072443 |
[2] |
MOORE H B, MOORE E E, GONZALEZ E, et al. Hyperfibrinolysis,physiologic fibrinolysis,and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and rele-vance to antifibrinolytic therapy[J]. J Trauma Acute Care Surg, 2014, 77(6):811-817.
doi: 10.1097/TA.0000000000000341 URL |
[3] |
HOLCOMB J B, TILLEY B C, BARANIUK S, et al. Transfusion of plasma, platelets, and red blood cells in a 1∶1∶ 1 vs. a 1∶1∶2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial[J]. JAMA, 2015, 313(5):471-482.
doi: 10.1001/jama.2015.12 URL |
[4] |
INNERHOFER P, FRIES D, MITTERMAYR M, et al. Reversal of traumainduced coagulopathy using frst-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group,openlabel,randomised trial[J]. Lancet Haematol, 2017, 4(6):e258-e271.
doi: 10.1016/S2352-3026(17)30077-7 URL |
[5] |
SCHÖCHL H, NIENABER U, MAEGELE M, et al. Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy[J]. Crit Care, 2011, 15(2):R83.
doi: 10.1186/cc10078 URL |
[6] |
STEIN P, KASERER A, SPRENGEL K, et al. Change of transfusion and treatment paradigm in major trauma patients[J]. Anaesthesia, 2017, 72(11):1317-1326.
doi: 10.1111/anae.13920 pmid: 28542848 |
[7] |
GONZALEZ E, MOORE E E, MOORE H B, et al. Goal-directed haemostatic resuscitation of trauma-induced coagulopathy: a pragmatic randomised clinical trial comparing a viscoelastic assay to conventional coagulation assays[J]. Ann Surg, 2016, 263(6):1051-1059.
doi: 10.1097/SLA.0000000000001608 URL |
[8] | COCHRANE C, CHINNA S, UM J Y, et al. Site-of-care viscoelastic assay in major trauma improves outcomes and is cost neutral compared with standard coagulation tests[J]. Diagnostics (Basel), 2020, 10(7):486. |
[9] |
LAMMERS D T, MARENCO C W, MORTE K R, et al. Viscoelastic testing in combat resuscitation: is it time for a new standard?[J]. J Trauma Acute Care Surg, 2020, 89(1):145-152.
doi: 10.1097/TA.0000000000002634 pmid: 32118819 |
[10] | CANNON J W. Hemorrhagic shock[J]. N Engl J Med, 2018, 378(19):1852-1853. |
[11] |
MOORE H B, GANDOS, IBA T, et al. Defining trauma-induced coagulopathy with respect to future implications for patient management: communication from the SSC of the ISTH[J]. J Thromb Haemost, 2020, 18(3):740-747.
doi: 10.1111/jth.14690 pmid: 32112533 |
[12] |
MEIZOSO J P, BARRETT C D, MOORE E E, et al. Advances in the management of coagulopathy in trauma: the role of viscoelastic hemostatic assays across all phases of trauma care[J]. Semin Thromb Hemost, 2022, 48(7):796-807.
doi: 10.1055/s-0042-1756305 pmid: 36113505 |
[13] |
FORT A C, DUDARYK R. Evolving science of trauma-induced coagulopathy[J]. Int Anesthesiol Clin, 2021, 59:25-30.
doi: 10.1097/AIA.0000000000000318 pmid: 33625062 |
[14] |
SPAHN D R, BOUILLON B, CERNY V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition[J]. Crit Care, 2019, 23(1):98.
doi: 10.1186/s13054-019-2347-3 |
[15] | 宋景春. 创伤性凝血病的概念变迁与展望[J]. 医学研究生学报, 2022, 35(1):5. |
SONG J C. Conceptual changes and perspectives of traumatic coagulopathy[J]. J Med Postgra, 2022, 35(1):5. | |
[16] | 曾庆波, 宋景春, 林青伟, 等. 创伤合并弥散性血管内凝血患者血栓弹力图诊断标准的临床研究[J]. 东南国防医药, 2018, 20(5):471-475. |
ZENG Q B, SONG J C, LIN Q W, et al. Clinical study on the diagnostic value of maximum amplitude for the heatstroke with DIC[J]. Mil Med J Southeast China, 2018, 20(5):471-475. | |
[17] |
SPASIANO A, BARBARINO C, MARANGONE A, et al. Early thromboelastography in acute traumatic coagulopathy: an observational study focusing on pre-hospital trauma care[J]. Eur J Trauma Emerg Surg, 2022, 48(1):431-439.
doi: 10.1007/s00068-020-01493-z |
[18] | 中国输血协会临床输血学专业委员会. 创伤性出血患者血液管理专家共识(2022年版)[J]. 中国临床新医学, 2022, 15(6):469-476. |
Working Party on Clinical Transfusion,Chinese Society of Blood Transfusion. Expert consensus on patient blood management for traumatic hemorrhage(2022 edition)[J]. Chin J New Clin Med, 2022, 15(6):469-476. | |
[19] |
SIMMONS J W, POWELL M F. Acute traumatic coagulopathy: pathophysiology and resuscitation[J]. Br J Anaesth, 2016, 117(suppl 3):iii31-iii43.
doi: 10.1093/bja/aew328 pmid: 27940454 |
[20] |
EINERSEN P M, MOORE E E, CHAPMAN M P, et al. Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion[J]. J Trauma Acute Care Surg, 2017, 82(1):114-119.
doi: 10.1097/TA.0000000000001270 pmid: 27805995 |
[21] |
ROSSAINT R, AFSHARI A, BOUILLON B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition[J]. Crit Care, 2023, 27(1):80.
doi: 10.1186/s13054-023-04327-7 |
[22] |
CRASH-2 TRIAL COLLABORATORS, SHAKUR H, ROBERTS I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial[J]. Lancet, 2010, 376(9734):23-32.
doi: 10.1016/S0140-6736(10)60835-5 pmid: 20554319 |
[23] |
MORRISON J J, DUBOSE J J, RASMUSSEN T E, et al. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study[J]. Arch Surg, 2012, 147(2):113-119.
doi: 10.1001/archsurg.2011.287 pmid: 22006852 |
[24] |
DIXON A L, MCCULLY B H, RICK E A, et al. Tranexamic acid administration in the feld does not afect admission thromboelastography after traumatic brain injury[J]. J Trauma Acute Care Surg, 2020, 89(5):900-907.
doi: 10.1097/TA.0000000000002932 URL |
[25] |
GRATZ J, GÜTING H, THORN S, et al. Protocolised thromboelastometric-guided haemostatic management in patients with traumatic brain injury: a pilot study[J]. Anaesthesia, 2019, 74(7):883-890.
doi: 10.1111/anae.14670 pmid: 31032890 |
[26] |
SCHÖCHL H, MAEGELE M, SOLOMON C, et al. Early and individualized goal-directed therapy for trauma-induced coagulopathy[J]. Scand J Trauma Resusc Emerg Med, 2012, 20:15.
doi: 10.1186/1757-7241-20-15 URL |
[27] |
SCHREIBER M A, DIFFERDING J, THORBORG P, et al. Hypercoagulability is most prevalent early after injury and in female patients[J]. J Trauma, 2005, 58(3):475-480.
doi: 10.1097/01.TA.0000153938.77777.26 URL |
[28] |
SUMISLAWSKI J J, KORNBLITH L Z, CONROY A S, et al. Dynamic coagulability after injury: is delaying venous thromboembolism chemoprophylaxis worth the wait?[J]. J Trauma Acute Care Surg, 2018, 85(5):907-914.
doi: 10.1097/TA.0000000000002048 pmid: 30124623 |
[29] |
VAN HAREN R M, VALLE E J, THORSON C M, et al. Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism[J]. J Trauma Acute Care Surg, 2014, 76(2):443-449.
doi: 10.1097/TA.0b013e3182a9d11d pmid: 24398771 |
[30] | SONG J C, YANG L K, ZHAO W, et al. Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy[J]. Mil Med Res, 2021, 8(1):15. |
[31] | KAKKOS S, KIRKILESIS G, CAPRINI J A, et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism[J]. Cochrane Database Syst Rev, 2022, 1(1):CD005258. |
[32] |
STETTLER G R, MOORE E E, MOORE H B, et al. Redefining post injury fibrinolysis phenotypes using two viscoelastic assays[J]. J Trauma Acute Care Surg, 2019, 86(4):679-685.
doi: 10.1097/TA.0000000000002165 URL |
[33] |
MEIZOSO J P, DUDARYK R, MULDER M B, et al. Increased risk of fibrinolysis shutdown among severely injured trauma patients receiving tranexamic acid[J]. J Trauma Acute Care Surg, 2018, 84(3):426-432.
doi: 10.1097/TA.0000000000001792 URL |
[34] |
COLEMAN J R, MOORE E E, MOORE H B, et al. Tranexamic acid disturbs the dynamics of postinjury fibrinolysis[J]. ANZ J Surg, 2020, 90(4):420-422.
doi: 10.1111/ans.v90.4 URL |
[35] |
MOORE H B, MOORE E E, LIRAS I N, et al. Acute fibrinolysis shutdown after injury occurs frequently and increases mortality: a multicenter evaluation of 2,540 severely injured patients[J]. J Am Coll Surg, 2016, 222(4):347-355.
doi: 10.1016/j.jamcollsurg.2016.01.006 URL |
[36] |
HAYES H V, DROEGE M E, FURNISH C J, et al. Admission thrombelastography does not guide dose adjustment of enoxaparin in trauma patients[J]. Surg Open Sci, 2020, 2(4):41-44.
doi: 10.1016/j.sopen.2020.03.003 URL |
[37] |
COLEMAN J R, KAY A B, MOORE E E, et al. It’s sooner than you think:blunt solid organ injury patients are already hypercoagulable upon hospital admission-results of a bi-institutional, prospective study[J]. Am J Surg, 2019, 218(6):1065-1073.
doi: 10.1016/j.amjsurg.2019.08.024 URL |
[38] |
LOUIS S G, VAN P Y, RIHA G M, et al. Thromboelastogram-guided enoxaparin dosing does not confer protection from deep venous thrombosis: a randomized controlled pilot trial[J]. J Trauma Acute Care Surg, 2014, 76(4):937-942.
doi: 10.1097/TA.0000000000000165 URL |
[39] |
BRILL J B, CALVO R Y, WALLACE J D, et al. Aspirin as added prophylaxis for deep vein thrombosis in trauma: a retrospective case-control study[J]. J Trauma Acute Care Surg, 2016, 80(4):625-630.
doi: 10.1097/TA.0000000000000977 pmid: 26808030 |
[40] |
LEY E J, BROWN C V R, MOORE E E, et al. Updated guidelines to reduce venous thromboembolism in trauma patients: a western trauma association critical decisions algorithm[J]. J Trauma Acute Care Surg, 2020, 89(5):971-981.
doi: 10.1097/TA.0000000000002830 URL |
[1] | 蔡飞宇 程二林 艾合买提江·玉素甫. 拱顶石穿支皮瓣修复手、足部软组织缺损[J]. 组织工程与重建外科杂志, 2022, 18(4): 311-. |
[2] | 董继英 吴珊 王棽 严敏 米晶 林琥燕 曾颖 张逸秋 宋晨璐 裴庆 朱婕 温晓钰 陆文婷 姚敏. 光电治疗对皮肤创伤性瘢痕的疗效研究[J]. 组织工程与重建外科杂志, 2022, 18(2): 133-. |
[3] | 李长生 李事成. 后路手术治疗急诊创伤性腰椎滑脱症的临床效果分析[J]. 组织工程与重建外科杂志, 2021, 17(6): 553-. |
[4] | 高嘉蔓 徐梁 姜陶然 俞哲元 曹德君. 肋硬骨-软骨联合隆鼻修复创伤后鼻畸形[J]. 组织工程与重建外科杂志, 2021, 17(3): 227-. |
[5] | 郭恩伟, 任大力, 章冰玉, 杨峰, 姚峪岚, 贾凌, 余琳, 冯刚. 创伤病人血清游离线粒体含量变化及其临床意义[J]. 外科理论与实践, 2020, 25(04): 315-321. |
[6] | 张立鹏, 王忠敏, 赵新建. 创伤性脾破裂行脾动脉介入栓塞与外科手术治疗的临床比较研究[J]. 外科理论与实践, 2020, 25(03): 222-226. |
[7] | 刘莉,刘宏超. 颈阔肌肌皮瓣在颌面部创伤修复中的应用[J]. 组织工程与重建外科杂志, 2018, 14(5): 272-274. |
[8] | 周思政,李青峰. 皮肤创伤愈合和增生性瘢痕动物模型的研究进展[J]. 组织工程与重建外科杂志, 2018, 14(1): 48-52. |
[9] | 姚峪岚, 郭恩伟, 任大力, 章冰玉, 杨峰, 陈庆, 刘兴晖, 罗前程, 冯刚. 创伤患者血清白细胞介素33和可溶性抑癌蛋白2水平与创伤的程度及预后关系[J]. 诊断学理论与实践, 2018, 17(03): 299-303. |
[10] | 赵华丽, 徐文鹏, 梁宗辉. 创伤性臂丛神经损伤的磁共振成像3D-FIESTA-C、IDEAL序列特征及诊断价值[J]. 诊断学理论与实践, 2018, 17(02): 197-201. |
[11] | 韩意, 黄梁, 史霆, 刘远滨, 许臻晔, 隋亮, 於平, 夏怡, 耿志超, 毛恩强, 王晓彦. 损伤控制理念在腹部急诊与外伤中的应用经验(附120例报告)[J]. 外科理论与实践, 2018, 23(02): 155-157. |
[12] | 冯宇,张睿,张玲,信维伟. 中小剂量地塞米松预防下肢急性创伤后软组织早期并发症的临床研究[J]. 组织工程与重建外科杂志, 2017, 13(1): 29-33. |
[13] | 徐秦岚, 朱飞, 王群,. 创伤后癫痫脑电图监测的应用及治疗[J]. 内科理论与实践, 2017, 12(02): 143-146. |
[14] | 华涛, 管一晖,. 创伤性脑损伤和氟18脱氧葡萄糖正电子发射断层摄影[J]. 内科理论与实践, 2017, 12(02): 147-151. |
[15] | 倪通天, 陈敏, 陆亚, 盛慧球, 周伟君, 毛恩强, 陈尔真,. 急性冠状动脉综合征患者抗血小板治疗中血栓弹力图的变化[J]. 诊断学理论与实践, 2016, 15(02): 142-147. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||