Beck E A
Schweiz Med Wochenschr. 1975 Jun 14;105(24):775-7.
Unexpected hemorrhage in surgery may be avoided whenever preoperative examinations have not detected a defect of hemostasis. A prospective study conducted before oral surgery demonstrated that a simple preoperative screening program was suitable for specific detection of patients with bleeding tendencies and to indicate the need for a more detailed evaluation of hemostasis. The screening program includes a detailed history with the aim of detecting congenital defects of hemostasis or bleeding tendencies due to prolonged, acquired disorders. The thromboplastin time (Quick test) should be performed to evaluate asymptomatic, acquired coagulation defects, especially liver disease, whereas the semiquantitative determination of platelets on blood smears is necessary to rule out thrombocytopenia. A dramatic complication of massive bleeding is the so-called "dilution syndrome" caused by simultaneous blood loss and transfusion of stored blood (or red cells alone), leading to a progressive reduction of clotting factors and platelets. Therapeutic and organizational measures which are necessary in this exceptional situation are briefly discussed.
只要术前检查未发现止血缺陷，手术中意外出血就可以避免。一项在口腔手术前进行的前瞻性研究表明，一个简单的术前筛查程序适用于特异性检测有出血倾向的患者，并表明有必要对止血进行更详细的评估。筛查程序包括详细的病史询问，目的是检测先天性止血缺陷或因长期获得性疾病导致的出血倾向。应进行凝血酶原时间（Quick试验）以评估无症状的获得性凝血缺陷，尤其是肝病，而对血涂片上的血小板进行半定量测定对于排除血小板减少症是必要的。大量出血的一个严重并发症是所谓的“稀释综合征”，它由失血和输注库存血（或仅红细胞）同时发生引起，导致凝血因子和血小板逐渐减少。本文简要讨论了在这种特殊情况下所需的治疗和组织措施。
