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[出血史的术前评估。奥地利麻醉、复苏与重症医学学会围手术期凝血工作组的建议]

[Preoperative evaluation of the bleeding history. Recommendations of the working group on perioperative coagulation of the Austrian Society for Anaesthesia, Resuscitation and Intensive Care].

作者信息

Pfanner G, Koscielny J, Pernerstorfer T, Gütl M, Perger P, Fries D, Hofmann N, Innerhofer P, Kneifl W, Neuner L, Schöchl H, Kozek-Langenecker S A

机构信息

Abteilung für Anästhesie und Intensivmedizin, Landeskrankenhaus Feldkirch, Feldkirch.

出版信息

Anaesthesist. 2007 Jun;56(6):604-11. doi: 10.1007/s00101-007-1182-0.

Abstract

Unexpected bleeding in the perioperative period is largely caused by impaired inherited or drug-induced primary haemostasis. Standard tests for plasma coagulation are predominantly employed to gauge the risk of bleeding. In accordance with several reports the subcommittee for perioperative coagulation (AGPG) of the Austrian Society of Anaesthesia, Resuscitation and Intensive Care (OGARI) recommends the use of a standardised questionnaire to detect an increased risk of bleeding. Accordingly, healthy patients of the American Society of Anesthesiologists (ASA) grades I and II without any suspicion of impaired haemostasis who are scheduled for procedures without expected transfusion requirements, need no standard tests for coagulation. In all other patients (including patients taking medication affecting coagulation, or patients who are unable to provide adequate information) platelet count, platelet function, aPTT, PT, and fibrinogen levels should be assessed.

摘要

围手术期意外出血主要是由遗传性或药物性原发性止血功能受损引起的。血浆凝血的标准检测主要用于评估出血风险。根据几份报告,奥地利麻醉、复苏与重症监护学会(OGARI)围手术期凝血小组委员会(AGPG)建议使用标准化问卷来检测出血风险增加的情况。因此,美国麻醉医师协会(ASA)I级和II级且无任何止血功能受损嫌疑、计划进行无预期输血需求手术的健康患者,无需进行凝血标准检测。在所有其他患者(包括正在服用影响凝血的药物的患者,或无法提供充分信息的患者)中,应评估血小板计数、血小板功能、活化部分凝血活酶时间(aPTT)、凝血酶原时间(PT)和纤维蛋白原水平。

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