Choi Pamela M, Vogel Adam M
Division of Pediatric Surgery, Department of Surgery, St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri, USA.
Curr Opin Pediatr. 2014 Jun;26(3):343-9. doi: 10.1097/MOP.0000000000000086.
To summarize our current understanding of the pathophysiology, diagnosis, and management of acute traumatic coagulopathy in children.
Traumatic coagulopathy is a complex process that leads to global dysfunction of the endogenous coagulation system and results in worse outcomes and increased mortality. Although the cause is multifactorial, it is common in severely injured patients and is driven by significant tissue injury and hypoperfusion. Viscoelastic coagulation tests have been established as a rapid and reliable method to assess traumatic coagulopathy. Additionally, massive transfusion protocols have improved outcomes in adults, but limited studies in pediatrics have not shown any difference in mortality.
Prospective studies are needed to determine how to best diagnose and manage acute traumatic coagulopathy in children.
总结我们目前对儿童急性创伤性凝血病的病理生理学、诊断和管理的理解。
创伤性凝血病是一个复杂的过程,会导致内源性凝血系统整体功能障碍,从而导致更差的预后和更高的死亡率。尽管其病因是多因素的,但在重伤患者中很常见,并且由严重的组织损伤和低灌注驱动。粘弹性凝血试验已被确立为评估创伤性凝血病的快速可靠方法。此外,大量输血方案改善了成人的预后,但儿科方面的有限研究并未显示死亡率有任何差异。
需要进行前瞻性研究,以确定如何最好地诊断和管理儿童急性创伤性凝血病。