Gando Satoshi
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
Nihon Geka Gakkai Zasshi. 2003 Dec;104(12):840-6.
During recent years, evidence has accumulated demonstrating bidirectional cross-talk in the classic neuroendocrine response as well as immune-mediated inflammatory response, and newly described coagulofibrinolytic response. This review outlines the influences that these systems exert on each other and discusses the implications of the coagulofibrinolytic response to the multiple-organ dysfunction syndrome (MODS) and patient prognosis. The results of the physiological coagulofibrinolytic response to physical insults such as surgery and trauma are hemostasis and wound healing. We stress that this response is nonspecific and is similar in all types of insult without exception. An abnormal hemostatic response to surgical insult is called disseminated intravascular coagulation (DIC). DIC associated with the sustained systemic inflammatory response syndrome (SIRS) in postsurgical insult leads to the development of MODS, which is the main determinant of patient outcome. To prevent the progression of DIC, new drugs like activated protein C which can control both coagulation and inflammation now appear promising.
近年来，越来越多的证据表明，在经典的神经内分泌反应、免疫介导的炎症反应以及新描述的凝血纤溶反应中存在双向交互作用。本综述概述了这些系统之间的相互影响，并讨论了凝血纤溶反应对多器官功能障碍综合征（MODS）及患者预后的影响。对手术和创伤等身体损伤产生的生理性凝血纤溶反应的结果是止血和伤口愈合。我们强调，这种反应是非特异性的，在所有类型的损伤中毫无例外都是相似的。对手术损伤的异常止血反应称为弥散性血管内凝血（DIC）。与术后损伤中持续的全身炎症反应综合征（SIRS）相关的DIC会导致MODS的发生，而MODS是患者预后的主要决定因素。为防止DIC的进展，像活化蛋白C这种能够同时控制凝血和炎症的新药现在看来很有前景。
