Kushimoto Shigeki, Kudo Daisuke, Kawazoe Yu
Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi 2-1, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Seiryo-machi 1-1, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
J Intensive Care. 2017 Jan 20;5(1):6. doi: 10.1186/s40560-016-0196-6.
Hemorrhage is the most important contributing factor of acute-phase mortality in trauma patients. Previously, traumatologists and investigators identified iatrogenic and resuscitation-associated causes of coagulopathic bleeding after traumatic injury, including hypothermia, metabolic acidosis, and dilutional coagulopathy that were recognized as primary drivers of bleeding after trauma. However, the last 10 years has seen a widespread paradigm shift in the resuscitation of critically injured patients, and there has been a dramatic evolution in our understanding of trauma-induced coagulopathy. Although there is no consensus regarding a definition or an approach to the classification and naming of trauma-associated coagulation impairment, trauma itself and/or traumatic shock-induced endogenous coagulopathy are both referred to as acute traumatic coagulopathy (ATC), and multifactorial trauma-associated coagulation impairment, including ATC and resuscitation-associated coagulopathy is recognized as trauma-induced coagulopathy. Understanding the pathophysiology of trauma-induced coagulopathy is vitally important, especially with respect to the critical issue of establishing therapeutic strategies for the management of patients with severe trauma.
出血是创伤患者急性期死亡的最重要促成因素。此前，创伤外科医生和研究人员确定了创伤性损伤后医源性和复苏相关的凝血病性出血原因，包括低温、代谢性酸中毒和稀释性凝血病，这些被认为是创伤后出血的主要驱动因素。然而，在过去10年中，危重伤患者的复苏出现了广泛的范式转变，我们对创伤性凝血病的理解也有了显著发展。尽管对于创伤相关凝血功能障碍的定义、分类和命名方法尚无共识，但创伤本身和/或创伤性休克诱导的内源性凝血病均被称为急性创伤性凝血病（ATC），包括ATC和复苏相关凝血病在内的多因素创伤相关凝血功能障碍被认为是创伤性凝血病。了解创伤性凝血病的病理生理学至关重要，尤其是在为严重创伤患者制定治疗策略这一关键问题上。
