Beynon Christopher, Wessels Lars, Unterberg Andreas W
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Semin Thromb Hemost. 2017 Jun;43(4):416-422. doi: 10.1055/s-0037-1599159. Epub 2017 Mar 27.
Coagulation disorders can have a major impact on the outcome of neurosurgical patients. The central nervous system is located within the closed space of the skull, and therefore, intracranial hemorrhage can lead to intracranial hypertension. Acute brain injury has been associated with alterations of various hemostatic parameters. Point-of-care (POC) techniques such as rotational thromboelastometry are able to identify markers of coagulopathy which are not reflected by standard assessment of hemostasis (e.g., hyperfibrinolysis). In patients with acute brain injury, POC test results have been associated with important outcome parameters such as mortality and need for neurosurgical intervention. POC devices have also been used to rapidly identify and quantify the effects of antithrombotic medication. In cases of life-threatening intracranial hemorrhage, this information can be valuable when deciding over administration of prohemostatic substances or immediate neurosurgical intervention. In elective neurosurgical procedures, POC devices can provide important information when unexpected bleeding occurs or in cases of prolonged operative time with subsequent blood loss. Initial experiences with POC devices in neurosurgical care have shown promising results but further studies are needed to characterize their full potential and limitations.
凝血功能障碍可对神经外科患者的预后产生重大影响。中枢神经系统位于颅骨的封闭空间内，因此，颅内出血可导致颅内高压。急性脑损伤与各种止血参数的改变有关。诸如旋转血栓弹力图等床旁（POC）技术能够识别凝血功能障碍的标志物，而这些标志物在标准止血评估中并未得到体现（例如，高纤维蛋白溶解）。在急性脑损伤患者中，POC检测结果与重要的预后参数相关，如死亡率和神经外科干预的必要性。POC设备也已用于快速识别和量化抗血栓药物的效果。在危及生命的颅内出血病例中，在决定是否给予促凝血物质或立即进行神经外科干预时，这些信息可能很有价值。在择期神经外科手术中，当意外出血发生或手术时间延长导致随后失血时，POC设备可以提供重要信息。POC设备在神经外科护理中的初步经验已显示出有前景的结果，但需要进一步研究以明确其全部潜力和局限性。
