Gerald A Grant
Duke University Medical Center, Durham, NC 27710, USA.
Surgery. 2007 Oct;142(4 Suppl):S55-60. doi: 10.1016/j.surg.2007.06.030.
Achieving and maintaining hemostasis in neurosurgical procedures is critical to the outcome. After trauma to the brain, a cascade of events initiated by tissue factor (TF) or thromboplastin results in a coagulation process that develops into an exaggerated fibrinolytic response, called disseminated intravascular coagulation (DIC). After a discussion of DIC, intraoperative adjuncts used to control bleeding, such as the gelatin sponge, thrombin, microcrystalline collagen, aprotinin, and fibrin sealants, are reviewed. Recombinant factor VIIa (rFVIIa) also is discussed, including its mechanism of action and use in neurosurgery. The ultra-early administration of rFVIIa also is covered, in both the military and the civilian settings.
在神经外科手术中实现并维持止血对手术结果至关重要。脑外伤后，由组织因子（TF）或凝血活酶引发的一系列事件会导致凝血过程，进而发展为一种过度的纤维蛋白溶解反应，即弥散性血管内凝血（DIC）。在讨论DIC之后，将对用于控制出血的术中辅助手段进行综述，如明胶海绵、凝血酶、微晶胶原、抑肽酶和纤维蛋白密封剂。还将讨论重组因子VIIa（rFVIIa），包括其作用机制及在神经外科中的应用。此外，还将涵盖在军事和民用环境中rFVIIa的超早期给药情况。
