RUSH Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL 60612-3833, USA.
Haemophilia. 2012 Nov;18(6):843-50. doi: 10.1111/j.1365-2516.2012.02918.x. Epub 2012 Aug 23.
Repeated haemarthroses and the consequences of blood in the joint contribute to blood induced joint disease (BIJD) in people with haemophilia (PWH). Prevention of bleeding, through medical management, is the standard of care in developed countries, but is not universally available due to financial and other barriers. Ice application, as part of R.I.C.E. (Rest, Ice, Compression, Elevation) or alone, is commonly recommended as an adjunct treatment to decrease bleeding, pain, tissue metabolism, oedema, and inflammation. This article will review evidence regarding local cooling by commonly used ice application methods, to decrease the temperature of the skin and intra-articular (IA) joint space and the resultant effects on haemostasis and coagulation. The general literature was reviewed for articles in English describing temperatures achievable in the skin and IA space using clinically relevant ice protocols, and the effect of cooling on haemostasis and coagulation. The literature demonstrates that typical methods of ice application can cool both the skin and IA space. Published, general literature studies have also consistently demonstrated that experimental cooling of blood and/or tissue, both in vitro and in vivo in humans and in animal models, can significantly impair coagulation and prolong bleeding. In PWH with acute haemarthrosis, ice application has potential to increase haemorrhage morbidity by further impairing coagulation and haemostasis. Ice has not been shown to improve overall outcome, stop bleeding nor swelling from haemarthrosis. Although ice can help manage acute, haemarthrosis-related pain, there are other available interventions that will not impair coagulation and haemostasis.
反复关节内出血和关节内血液积聚会导致血友病患者（PWH）发生血源性关节病（BIJD）。在发达国家，通过医疗管理预防出血是标准的治疗方法，但由于经济和其他障碍，这种方法并非普遍适用。冰袋应用，作为 RICE（休息、冰敷、加压包扎、抬高）的一部分或单独使用，通常被推荐作为一种辅助治疗方法，以减少出血、疼痛、组织代谢、水肿和炎症。本文将回顾关于局部冷却的证据，即使用常见的冰袋应用方法降低皮肤和关节内（IA）关节空间的温度，以及对止血和凝血的影响。本文综述了英文文献中描述使用临床相关冰袋方案可实现的皮肤和 IA 空间温度的文章，以及冷却对止血和凝血的影响。文献表明，典型的冰袋应用方法可以冷却皮肤和 IA 空间。已发表的一般文献研究也一致表明，在体外和体内（包括人类和动物模型）对血液和/或组织进行实验性冷却可以显著损害凝血功能并延长出血时间。在急性关节积血的 PWH 中，冰袋应用有可能通过进一步损害凝血和止血功能增加出血的发病率。冰袋应用尚未显示出可以改善总体预后、停止出血或减轻关节积血引起的肿胀。尽管冰袋可以帮助缓解急性关节积血相关疼痛，但还有其他不会损害凝血和止血功能的可用干预措施。
