Weber C F, Zacharowski K, Brün K, Volk T, Martin E O, Hofer S, Kreuer S
Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt a. M., Deutschland.
Anaesthesist. 2013 Jun;62(6):464-72. doi: 10.1007/s00101-013-2184-8.
During perioperative treatment of coagulopathic patients the so-called Point-of-Care (POC) analyses enable more rapidly available and more comprehensive hemostatic analyses compared to routinely performed conventional coagulation testing, such as activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen concentration and platelet count. In this review article a hemotherapy algorithm is presented which is based on viscoelastic and aggregometric POC measurements. The algorithm was designed double sided and consists of a general and a special part. The general part contains boxes and fields for sociodemographic data and gives general recommendations for coagulation management and therapy specifications for particular patient collectives and presents proposals for emergency reversal of anticoagulation therapy. The special part refers to basic physiological conditions for hemostasis and asks for measurement results of clot initiation, clot firmness, clot stability and platelet function analyses. Reference values were defined for each parameter and therapeutic options are presented. In cases of persistent coagulopathy despite algorithm-conform therapy, the algorithm could be run through once again. Finally, the algorithm presents therapeutic options for an ultima ratio therapy approach.
在凝血病患者的围手术期治疗中，与常规进行的传统凝血检测（如活化部分凝血活酶时间（aPTT）、国际标准化比值（INR）、纤维蛋白原浓度和血小板计数）相比，所谓的即时检验（POC）分析能够提供更快可得且更全面的止血分析。在这篇综述文章中，提出了一种基于粘弹性和凝集性POC测量的血液治疗算法。该算法设计为双面的，由一个通用部分和一个特殊部分组成。通用部分包含社会人口统计学数据的框和字段，并给出凝血管理的一般建议以及针对特定患者群体的治疗规范，还提出了抗凝治疗紧急逆转的建议。特殊部分涉及止血的基本生理条件，并要求提供凝血启动、凝块硬度、凝块稳定性和血小板功能分析的测量结果。为每个参数定义了参考值，并给出了治疗选择。在尽管采用符合算法的治疗但仍存在持续性凝血病的情况下，该算法可以再次运行。最后，该算法给出了终极治疗方法的治疗选择。
