Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.
Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida.
J Surg Res. 2020 Dec;256:536-542. doi: 10.1016/j.jss.2020.07.010. Epub 2020 Aug 13.
Antithrombin deficiency (ATD) was described in 1965 by Olav Egeberg as the first known inherited form of thrombophilia. Today, it is understood that ATDs can be congenital or acquired, leading to qualitative, quantitative, or mixed abnormalities in antithrombin (AT). All ATDs ultimately hinder AT's ability to serve as an endogenous anticoagulant and antiinflammatory agent. As a result, ATD patients possess higher risk for thromboembolism and can develop recurrent venous and arterial thromboses. Because heparin relies on AT to augment its physiologic function, patients with ATD often exhibit profound heparin resistance. Although rare as a genetic disorder, acquired forms of ATD are seen with surprising frequency in critically ill patients. This review discusses ATD in the context of surgical critical care with specific relevance to trauma, thermal burns, cardiothoracic surgery, and sepsis.
抗凝血酶缺陷症（ATD）于 1965 年由 Olav Egeberg 首次描述，是已知的第一种遗传性血栓形成倾向。如今，人们已经了解到 ATD 可以是先天性的也可以是后天获得的，导致抗凝血酶（AT）的质量、数量或混合异常。所有 ATD 最终都会阻碍 AT 作为内源性抗凝剂和抗炎剂的作用。因此，ATD 患者具有更高的血栓栓塞风险，并且可能会发生复发性静脉和动脉血栓形成。由于肝素依赖于 AT 来增强其生理功能，因此 ATD 患者通常表现出严重的肝素抵抗。尽管作为一种遗传疾病较为罕见，但后天获得性 ATD 在危重症患者中却以惊人的频率出现。本篇综述讨论了外科危重病护理背景下的 ATD，特别关注创伤、热烧伤、心胸外科和脓毒症。
