Department of Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy -
Department of Anesthesia, Hospital Clinic, Barcelona, Spain.
Minerva Anestesiol. 2019 Jul;85(7):782-798. doi: 10.23736/S0375-9393.19.13468-2. Epub 2019 Apr 2.
Recent data demonstrated that amongst patients undergoing elective surgery the prevalence of cirrhosis is 0.8% equating to approximately 25 million cirrhotic patients undergoing surgery each year worldwide. Overall, the presence of cirrhosis is independently associated with 47% increased risk of postoperative complications and over two and a half-increased risk of in-hospital mortality in patients undergoing elective surgery. In particular, perioperative patients with chronic liver disease have long been assumed to have a major bleeding risk on the basis of abnormal results for standard tests of hemostasis. However, recent evidence outlined significant changes to traditional knowledge and beliefs and, nowadays, with more sophisticated laboratory tests, it has been shown that patients with chronic liver disease may be in hemostatic balance as a result of concomitant changes in both pro- and antihemostatic pathways. The aim of this paper endorsed by the Liver Intensive Care Group of Europe was to provide an up-to-date overview of coagulation management in perioperative patients with chronic liver disease focusing on patient blood management, monitoring of hemostasis, and current role of hemostatic agents.
最近的数据表明，在接受择期手术的患者中，肝硬化的患病率为 0.8%，相当于全球每年约有 2500 万肝硬化患者接受手术。总体而言，肝硬化的存在与术后并发症风险增加 47%以及择期手术患者住院死亡率增加两倍半独立相关。特别是，基于止血标准检测的异常结果，长期以来，围手术期慢性肝病患者一直被认为存在大出血风险。然而，最近的证据概述了对传统知识和观念的重大改变，如今，随着更复杂的实验室检测的出现，已经表明慢性肝病患者可能由于促凝和抗凝途径的同时改变而处于止血平衡状态。本文由欧洲肝脏重症监护组支持，旨在提供围手术期慢性肝病患者凝血管理的最新概述，重点关注患者血液管理、止血监测以及止血剂的当前作用。
