Ganter M T, Hofer C K
Institut für Anästhesiologie, Universitätsspital Zürich, Rämistrasse 100, Zürich, Switzerland.
Chirurg. 2011 Jul;82(7):635-443; quiz 644. doi: 10.1007/s00104-010-2052-x.
The coagulation system is a complex network of interacting proteins and cells with extensive sensitivity, amplification and control pathways. The system represents a delicate balance between procoagulant and anticoagulant as well as profibrinolytic and antifibrinolytic activities. Clinically relevant phenotypes, e.g. bleeding and thrombosis, occur immediately when this balance is no longer in equilibrium. A correct understanding of the complex coagulation pathophysiology in the perioperative setting is essential for an effective treatment. In a bleeding patient, patient's history, clinical findings, routine and advanced laboratory coagulation testing as well as point-of-care coagulation monitoring help to reliably and readily identify the underlying coagulation disorder. Modern coagulation management is proactive, individualized, balanced and follows clearly defined algorithms. Coagulopathic bleeding can be successfully controlled with specific interventions in the coagulation system.
凝血系统是一个由相互作用的蛋白质和细胞组成的复杂网络，具有广泛的敏感性、放大和控制途径。该系统代表了促凝和抗凝以及纤溶和抗纤溶活性之间的微妙平衡。当这种平衡不再处于均衡状态时，临床上相关的表型，如出血和血栓形成，会立即出现。正确理解围手术期复杂的凝血病理生理学对于有效治疗至关重要。对于出血患者，患者病史、临床发现、常规和先进的实验室凝血检测以及即时凝血监测有助于可靠且快速地识别潜在的凝血障碍。现代凝血管理是积极主动的、个性化的、平衡的且遵循明确界定的算法。通过对凝血系统的特定干预，可以成功控制凝血病性出血。
