Hehne H J, Nyman D, Burri H, Wolff G
Schweiz Med Wochenschr. 1976 May 15;106(20):671-6.
Coagulation disorders in hemorrhagic shock need not represent an isolated intravascular coagulation. They may also occur as a complex of local disseminated intravascular consumption, extravascular consumption, dilution, and reduced synthesis of coagulation factors. In the severely bleeding patient with hemorrhagic diathesis heparin is contraindicated because it does not normalize coagulability. Therefore, it fails to stop hemorrhage and shock remains untreatable. Fresh frozen plasma, however, has proved to be suitable as simultaneous substitution therapy of coagulopathy and of hypovolemic shock. 11 patients suffering from traumatic-hemorrhagic shock associated with intravascular coagulation and hemorrhagic diathesis were successfully treated with fresh frozen plasma, after conventional shock therapy had failed over a period of hours.
出血性休克中的凝血障碍不一定仅表现为单纯的血管内凝血。它们也可能以局部弥散性血管内消耗、血管外消耗、稀释以及凝血因子合成减少的复杂形式出现。对于有出血素质的严重出血患者,肝素是禁忌的,因为它不能使凝血能力恢复正常。因此,它无法止血,休克仍无法治疗。然而,新鲜冰冻血浆已被证明适合作为凝血病和低血容量性休克的同步替代疗法。11例患有与血管内凝血和出血素质相关的创伤性出血性休克的患者,在常规休克治疗数小时失败后,成功地接受了新鲜冰冻血浆治疗。