Dries D J
Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
New Horiz. 1996 May;4(2):276-88.
The traditional approach to hemostatic disorders in the injured patient has focused on bleeding rather than a hypercoagulable state. This strategy continues despite growing evidence from studies of coagulation disorders in other patient groups highlighting loss of organ function secondary to inappropriate coagulation rather than hemorrhage. While traditional testing is useful in screening for low levels of coagulation factors or platelet dysfunction, only obvious bleeding or significant fibrinolysis is identified. Cellular interactions, in particular those of the vascular endothelium, are not taken into account by these assays. More than 20 years have passed since coagulation abnormalities were reported in patients with severe infection. Despite recognition of this association in sepsis, we are only beginning to understand how coagulation abnormalities develop in injury and to consider strategies to counter them. While hemorrhage may be successfully treated in patients following trauma, thrombosis in the microcirculation often contributes to end-organ damage with irreversible ischemic changes that may lead to death.
对于受伤患者止血障碍的传统处理方法一直聚焦于出血而非高凝状态。尽管其他患者群体凝血障碍研究的证据不断增多，强调因不适当凝血而非出血导致器官功能丧失，但这一策略仍在继续。虽然传统检测有助于筛查低水平凝血因子或血小板功能障碍，但只能识别明显出血或显著纤溶。这些检测未考虑细胞间相互作用，尤其是血管内皮细胞的相互作用。自报道严重感染患者存在凝血异常以来，已过去20多年。尽管在脓毒症中已认识到这种关联，但我们才刚刚开始了解损伤时凝血异常是如何发生的，并考虑应对策略。虽然创伤后患者的出血可能得到成功治疗，但微循环中的血栓形成往往会导致终末器官损伤，出现不可逆的缺血性改变，可能导致死亡。
