Owen C A, Bowie E J
J Neurosurg. 1979 Aug;51(2):137-42. doi: 10.3171/jns.1979.51.2.0137.
Every surgical procedure taxes the hemostatic defenses of the patient. If his hemostatic mechanism is sound, he is unlikely to have a bleeding problem during or after an operation, unless, of course, a suture or clip slips off. Two classes of patients do present bleeding problems to the surgeon. One group has a pre-existing bleeding tendency, the other acquires it during or after the operation. The recognition of patients with severe hemostatic disabilities, such as hemophilia, presents no problem since the patient is aware of the disease. The mild bleeder is less likely to be detected by screening tests than by adroit questioning. The major hemostatic defect that may develop during an operation, or shortly thereafter, is disseminated intravascular coagulation. This syndrome, always secondary, may accompany shock, mismatched blood transfusion, septicemia, or extensive malignancy. Its prevention or early recongnition is much easier than treatment after circulating platelets and some coagulation factors have been consumed and fibrinolysis is destroying fibrin and fibrinogen.
每一台外科手术都会使患者的止血防御系统承受压力。如果患者的止血机制健全，那么他在手术期间或术后不太可能出现出血问题，当然，除非缝线或夹子脱落。有两类患者确实会给外科医生带来出血问题。一类患者有既往出血倾向，另一类则在手术期间或术后出现出血倾向。对于患有严重止血障碍（如血友病）的患者，识别起来并不困难，因为患者自己知道患有这种疾病。与巧妙的询问相比，轻度出血者通过筛查试验更不容易被发现。手术期间或术后不久可能出现的主要止血缺陷是弥散性血管内凝血。这种综合征总是继发性的，可能伴有休克、血型不匹配输血、败血症或广泛的恶性肿瘤。在循环中的血小板和一些凝血因子被消耗且纤维蛋白溶解正在破坏纤维蛋白和纤维蛋白原之后，预防或早期识别这种综合征要比治疗容易得多。
