Stein Deborah M, Scalea Thomas M
University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
Adv Surg. 2012;46:237-53. doi: 10.1016/j.yasu.2012.03.008.
TICS is a complex disease that is clearly multifactorial in the traumatically injured patient (Fig. 2). Although systemic inflammation that occurs directly as a result of injury plays the most prominent role, the local tissue and organ injury effects of trauma not only cause local capillary leak and edema but also further amplify the SIRS response. High volume fluid administration and hypoproteinemic states further exacerbate the problem. All of this leads to organ dysfunction and failure, which is the third leading cause of death following injury. Strategies to treat TICS and attenuate its effects once it occurs by targeting inflammatory pathways have been wholly unsuccessful. The mainstay of therapy for TICS is prevention and minimization of its lethal effects. Newer resuscitation strategies such as hemostatic resuscitation and early goal-directed therapies are currently the best available strategies to combat TICS. Whether these result in better outcomes remains to be seen and the authors anxiously await the results of well-designed prospective trials.
创伤诱导的凝血病（TICS）是一种复杂疾病，在创伤患者中显然是多因素导致的（图2）。尽管直接由损伤导致的全身炎症起最主要作用，但创伤的局部组织和器官损伤效应不仅会引起局部毛细血管渗漏和水肿，还会进一步放大全身炎症反应综合征（SIRS）反应。大量补液和低蛋白血症状态会进一步加剧该问题。所有这些都会导致器官功能障碍和衰竭，这是受伤后第三大死亡原因。通过靶向炎症途径治疗TICS并在其发生后减轻其影响的策略一直完全没有成功。TICS治疗的主要手段是预防并将其致命影响降至最低。诸如止血复苏和早期目标导向治疗等更新的复苏策略目前是对抗TICS的最佳可用策略。这些策略是否会带来更好的结果还有待观察，作者们急切地等待精心设计的前瞻性试验的结果。
