Popović N, Blagojević Z, Nikolić V, Arsenijević Lj, Karamarković A, Stefanović B, Kojić Z
Institut za anesteziju KCS, Beograd.
Acta Chir Iugosl. 2006;53(4):89-92. doi: 10.2298/aci0604089p.
Trauma is disease of the young, mainly affecting people between 15-40 years of age. Uncontrolled massive bleeding is the leading cause of early in-hospital mortality, within 48h of admission, and the second leading cause of prehospital death in victims of both military and civilian trauma, accounting for 40-45% of the total fatalities. Coagulopathy develops early after injury and is present in 25-36% of trauma victims upon admission to the emergency department. Coagulopathy correlates to the severity of trauma and is associated with an increased risk of mortality. The aim of this paper is to explain pathophysiology of developing coagulopathy in trauma. The coagulopathy in the trauma patient is complex and multifactorial. It includes: dilutional coagulopathy, hypothermia, acidosis, hyperfibrinolysis, anemia and consumption coagulopathy. When the patient develops the so called "lethal triad" of hypothermia, acidosis and coagulopathy, surgical restoration of vascular integrity may be insufficient to achieve a deffinitive control of blood loss and non-mechanical bleeding from small vessels, usually terminated by spontaneous coagulation, becomes a life-threatening condition.
创伤是年轻人易患的疾病，主要影响15至40岁的人群。不受控制的大量出血是入院后48小时内院内早期死亡的主要原因，也是军事和民用创伤受害者院前死亡的第二大原因，占总死亡人数的40%至45%。凝血功能障碍在受伤后早期出现，急诊科收治的创伤患者中有25%至36%存在凝血功能障碍。凝血功能障碍与创伤严重程度相关，并与死亡风险增加有关。本文旨在解释创伤中发生凝血功能障碍的病理生理学。创伤患者的凝血功能障碍是复杂且多因素的。它包括：稀释性凝血功能障碍、体温过低、酸中毒、纤维蛋白溶解亢进、贫血和消耗性凝血功能障碍。当患者出现体温过低、酸中毒和凝血功能障碍这一所谓的“致命三联征”时，手术恢复血管完整性可能不足以实现对失血的最终控制，小血管的非机械性出血（通常通过自发凝血终止）会成为危及生命的状况。
