Haemostasis Research Unit, Centre for Haemophilia and Thrombosis, Guy's and St Thomas Hospital & NHS Foundation Trust & King's College London School of Medicine, London, UK.
Haemophilia. 2010 Nov;16(6):926-31. doi: 10.1111/j.1365-2516.2010.02275.x.
Muscle haematomas (MH) represent 10-25% of all bleeds in patients with severe haemophilia. We performed a cross-sectional survey on current practice in the management of MH with participation from 22 consultants. The respondents reported 492 MH/year, corresponding an average of 25/centre, mostly associated with trauma. Iliopsoas (55%), calf (18%) and thigh (18%) bleeds were scored as most serious. Half of the respondents distinguished between contusion and strains, whereas the majority (68.2%) did not categorize bleedings as intra- or intermuscular, although 77.3% routinely used ultrasound. Half of the respondents used a standard protocol for the management of MH. Twenty of 22 (90.9%) respondents offered physiotherapy in the hospital following MH, with no clear consensus on timing and type of treatment. In a theoretical case, for a 70-kg patient with a soleus triceps haematoma, the average initial dose of factor VIII was 2730 U (range: 1750-4000) twice daily for 3-5 days. In a similar case of a patient with inhibitors, 31.8% reported first-line and only use of either recombinant factor VIIa (rFVIIa) or activated prothrombin complex concentrate (APCC), while 36.4% switched between bypassing agents. Using rFVIIa, the median dose was 100 μg/kg (range: 85-270) and with APCC, the median dose was 70 U kg(-1) (range: 50-100). The majority (68.2%) did not use antifibrinolytics. Resolution of pain (81.8% & 77.3%) was regarded as the key clinical marker of arrest of bleeding as compared with diminished swelling and improved range of motion. The survey outlines limited consensus in the management of MH in patients with haemophilia and highlights potential topics for future studies.
肌肉血肿（MH）占严重血友病患者所有出血的 10-25%。我们对 22 位顾问参与的 MH 管理现状进行了横断面调查。报告称，每年有 492 例 MH，平均每个中心 25 例，主要与创伤有关。髂腰肌（55%）、小腿（18%）和大腿（18%）出血被评为最严重的。半数受访者区分了挫伤和拉伤，而大多数（68.2%）没有将出血分为肌内或肌间，但 77.3%的人常规使用超声。半数受访者使用标准方案管理 MH。22 位受访者中有 20 位（90.9%）在 MH 后在医院提供物理治疗，但对于治疗时机和类型没有明确共识。在一个理论病例中，对于一名 70 公斤的患者，其比目鱼肌三头肌血肿，VIII 因子的平均初始剂量为 2730U（范围：1750-4000），每日两次，持续 3-5 天。在类似的有抑制剂的患者中，31.8%报告第一线且仅使用重组凝血因子 VIIa（rFVIIa）或活化的凝血酶原复合物浓缩物（APCC），而 36.4%在旁路制剂之间切换。使用 rFVIIa 时，中位数剂量为 100μg/kg（范围：85-270），使用 APCC 时，中位数剂量为 70U/kg（范围：50-100）。大多数（68.2%）不使用抗纤维蛋白溶解剂。与肿胀减轻和运动范围改善相比，疼痛缓解（81.8%和 77.3%）被认为是出血停止的关键临床标志物。该调查概述了血友病患者 MH 管理方面的有限共识，并突出了未来研究的潜在主题。
