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[不明原因出血性疾病:围手术期和围操作期的定义、诊断与管理]

[Bleeding disorders of unknown cause : Definition, diagnostics and management in the perioperative and periprocedural setting].

作者信息

Pilch Jan, Schneider Sven Oliver, Schulze-Berge Julia, Graf Marius, Kleinschmidt Stefan

机构信息

Institut für Transfusionsmedizin und Hämostaseologie, Universitätsklinikum Augsburg, Augsburg, Deutschland.

Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes und Medizinische Fakultät, Universität des Saarlandes, 66421, Homburg (Saar), Deutschland.

出版信息

Anaesthesiologie. 2025 Aug;74(8):540-550. doi: 10.1007/s00101-025-01558-x.

Abstract

Perioperative and periprocedural bleeding complications substantially increase the morbidity and mortality. The main causes are intervention-related or trauma-related factors, patient-related factors, such as congenital or acquired hemostatic disorders as well as pre-existing medicinal anticoagulation as a result of the underlying disease. Despite the variety of currently available test procedures, the constellation of a clinically relevant bleeding situation without tangible pathological laboratory findings or causes often occurs. This constellation, called bleeding disorder of unknown cause (BDUC), requires a structured diagnostic and therapeutic approach to improve the outcome of the patient, to avoid a therapeutic polypragmasia and to limit the administration of hemostatics to that which is absolutely necessary. The close monitoring of these patients, whose quality of life is often restricted, is meaningful and necessary.

摘要

围手术期和围操作期出血并发症会显著增加发病率和死亡率。主要原因包括与干预或创伤相关的因素、患者相关因素,如先天性或获得性止血障碍,以及因基础疾病而预先存在的药物抗凝。尽管目前有各种各样的检测方法,但临床上相关出血情况却常常出现,却没有明显的病理实验室检查结果或病因。这种情况被称为不明原因出血障碍(BDUC),需要一种结构化的诊断和治疗方法,以改善患者的预后,避免治疗上的多药并用,并将止血剂的使用限制在绝对必要的范围内。对这些生活质量往往受到限制的患者进行密切监测是有意义且必要的。

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