Jámbor Csilla, Heindl Bernhard, Spannagl Michael, Rolfes Caroline, Dinges Gerhard Klaus, Frietsch Thomas
Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2009 Mar;44(3):200-9; quiz 211. doi: 10.1055/s-0029-1215551. Epub 2009 Mar 5.
Massively transfused multiple trauma patients commonly develop a complex coagulopathy which needs immediate treatment. Near-patient diagnostic methods are available for the management of this coagulopathy and for the guidance of the therapeutic options with blood products and haemostatic drugs: conventional laboratory analysis methods adapted to the point-of-care (POC) situation (blood gas analysis, point of care PT, APTT and platelet count), and the complex whole blood methods used for near-patient coagulation monitoring (thromboelastometry and platelet function analysis). Based on the new Guidelines of the German Medical Association for the use of blood and plasma derivates, interventions with blood products and haemostatic drugs in multiple trauma patients are suggested. The diagnostic value of near-patient methods for coagulation monitoring is discussed.
大量输血的多发伤患者通常会出现复杂的凝血病,需要立即治疗。有床旁诊断方法可用于管理这种凝血病,并指导血液制品和止血药物的治疗选择:适用于床旁(POC)情况的传统实验室分析方法(血气分析、床旁PT、APTT和血小板计数),以及用于床旁凝血监测的复杂全血方法(血栓弹力图和血小板功能分析)。基于德国医学协会关于血液和血浆衍生物使用的新指南,建议对多发伤患者进行血液制品和止血药物干预。本文讨论了床旁凝血监测方法的诊断价值。