Haas Thorsten, Mauch Jacqueline, Weiss Markus, Schmugge Markus
Department of Anaesthesia, University Children's Hospital Zurich, Switzerland.
Transfus Med Hemother. 2012 Apr;39(2):114-119. doi: 10.1159/000337245. Epub 2012 Mar 8.
Perioperative dilutional coagulopathy is a major coagulation disorder during adult and pediatric surgery. Although the main underlying mechanisms are comparable, data of the development and management of dilutional coagulopathy in children are scarce. Observational data showed that intraoperative coagulation disorders mainly based on complex disturbances of clot firmness including acquired fibrinogen as well as factor XIII deficiencies, while clotting time and platelet counts remained fairly stable. A fast and reliable monitoring of the entire coagulation process (e.g. thrombelastometry) might be of extreme value for detection and guidance of effective coagulation management. Although the transfusion of fresh frozen plasma was recommended in several guidelines, the use of coagulation factors might offer an alternative and potentially superior approach in managing perioperative coagulation disorders. Further studies are urgently needed to determine the efficacy of modern coagulation management.
围手术期稀释性凝血障碍是成人和儿童手术期间的一种主要凝血障碍。尽管其主要潜在机制相似，但关于儿童稀释性凝血障碍的发生和管理的数据却很匮乏。观察性数据表明，术中凝血障碍主要基于包括获得性纤维蛋白原以及因子 XIII 缺乏在内的凝块硬度复杂紊乱，而凝血时间和血小板计数保持相对稳定。对整个凝血过程进行快速可靠的监测（如血栓弹力图）对于有效凝血管理的检测和指导可能具有极高价值。尽管多项指南推荐输注新鲜冰冻血浆，但使用凝血因子可能为围手术期凝血障碍的管理提供一种替代且可能更优的方法。迫切需要进一步研究以确定现代凝血管理的疗效。
