Messmore H L, Godwin J
Division of Hematology/Oncology, Loyola University of Chicago, Stritch School of Medicine, Maywood, Illinois.
Med Clin North Am. 1994 May;78(3):625-34. doi: 10.1016/s0025-7125(16)30150-x.
The key to avoidance of hemostatic failure during surgery is to be able to identify the high-risk patient and make a diagnosis and treat the defect before surgery. A thorough history and physical examination are mandatory in this regard. A screening coagulation profile is not a substitute for the history and physical examination. Selected presurgical tests are useful in major surgical cases and in certain high-risk cases. Otolaryngologists have advised presurgical testing for patients undergoing tonsillectomy, but the subject of presurgical testing is still a matter for investigation in view of the necessity for cost containment. Knowledge of the hemostatic system combined with a knowledge of the tests available to diagnose coagulation defects permits a rational approach to therapy of the bleeding surgical patient.
手术中避免止血失败的关键在于能够识别高危患者，并在手术前做出诊断和治疗缺陷。在这方面，全面的病史和体格检查是必不可少的。筛查凝血指标并不能替代病史和体格检查。选定的术前检查在重大手术病例和某些高危病例中很有用。耳鼻喉科医生建议对接受扁桃体切除术的患者进行术前检查，但鉴于控制成本的必要性，术前检查的问题仍有待研究。了解止血系统并结合可用于诊断凝血缺陷的检查知识，有助于对出血手术患者进行合理的治疗。
