基于出血性凝血衰竭理念对创伤性凝血病的预测

陈少川; 童华生

doi:10.16766/j.cnki.issn.1674-4152.002423

基于出血性凝血衰竭理念对创伤性凝血病的预测

doi: 10.16766/j.cnki.issn.1674-4152.002423

陈少川¹,
童华生^{1, 2, ,}

1.
南方医科大学第一临床医学院，广东广州 510515
2.
南部战区总医院急诊科，广东广州 510030

基金项目:

国家自然科学基金项目 81671896

军事医学创新工程专项 18CXZ032

详细信息

通讯作者:
童华生，E-mail：fimmuths@163.com

中图分类号: R641 R605.972
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- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-09
- 网络出版日期: 2022-08-20

Prediction of traumatic coagulation disease based on the concept of hemorrhagic coagulation failure

CHEN Shao-chuan¹,
TONG Hua-sheng^{1, 2
, ,}

1.
The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, China

摘要

摘要: 严重创伤救治是全球性难题，全球每年因严重创伤死亡人数约占总死亡数的10%，而创伤性凝血病(TIC)导致创伤性大出血占创伤患者死因的30%~40%。TIC由多因素与多系统所综合诱发，预防和纠正TIC是严重创伤或多发伤管理的核心之一，而复杂的发生机制致使其诊断标准滞后与救治不及时。有研究提出的出血性凝血衰竭理论认为：严重组织损伤和失血，导致休克低灌注与氧债的发生，同时伴随血管内皮的一系列病变反应启动了TIC的发生。本文基于这一机制理论，尝试建立能够预测TIC发生的综合指标组合。通过检索国内外相关文献，综述了在血性凝血衰竭过程中的重要临床指标变化，以及这些指标对TIC的发生与进展的影响。创伤严重程度评分，代表出血休克的血红蛋白变化、平均动脉压和休克指数，反映低灌注与无氧代谢的乳酸、pH值与碱剩余指标，血管内皮糖萼、syndecan-1、血管内皮细胞标记物血栓调节蛋白(TM)与血管性血友病因子(VWF)因子等指标均具有评估患者TIC发生发展的潜在价值。因此，从出血性凝血衰竭发生机制的角度出发，了解由严重组织创伤、创伤性休克和组织低灌注，继而导致的血管内皮病变过程所诱导的TIC发生机制，能够为实施TIC的早期诊断乃至救治提供可靠的指标组合。
- 严重创伤 /
- 创伤性凝血病 /
- 血管内皮 /
- 糖萼
Abstract: The treatment of severe trauma is a global problem. The deaths due to severe trauma accounts for about 10% of the total deaths every year, and the traumatic hemorrhage that caused by trauma-induced coagulopathy (TIC) accounts for 30%-40% of deaths in trauma patients. TIC is comprehensively induced by multiple factors and systems, and the prevention and treatment of TIC is one of the cores of the management of severe trauma or multiple injuries. The complicated mechanism makes the diagnosis and treatment of TIC not timely. The hemorrhagic coagulation failure believes that sever tissue damage and blood loss lead to shock hypoperfusion and oxygen debt, and a series of pathological reactions of the vascular endothelium initiates the occurrence of TIC. This paper attempts to establish a combination of indicators to predict the occurrence of TIC on the basis of this theory. By selecting relevant domestic and foreign literature, the important clinical indicators that involved in the process of blood coagulation failure and the impact of them on the occurrence and progress of TIC were reviewed. The injury severity score, hemoglobin changes, mean arterial pressure, shock index, lactic acid, pH, alkali excess, vascular endothelial glycocalyx, syndecan-1, thrombomodulin (TM) and von Willebrand factor(VWF) factors all have the potential value of evaluating the occurrence and development of TIC in patients. From the perspective of the mechanism of hemorrhagic coagulation failure understanding the mechanism of TIC followed severe tissue trauma, traumatic shock and tissue hypoperfusion and the vascular endothelial disease subsequently, can be used for the implementation of early diagnosis and even treatment of TIC, and also provide reliable combined indicators.
- Severe trauma /
- Trauma-induced coagulopathy /
- Vascular endothelium /
- Endothelial glycocalyx

HTML全文

图 1 出血性血液衰竭启动和进展示意图

注：严重组织损伤和失血，休克低灌注、氧债发生，在伴随炎症反应和交感肾上腺素激活作用下血管内皮脱落，内皮细胞暴露，血管内皮病发生，启动凝血，最终导致凝血因子活性降低、纤溶亢进和血小板功能障碍，引发出血性血液衰竭。图片来源于文献[14]。

Figure 1. Schematic diagram of initiation and progression of hemorrhagic blood failure

下载: 全尺寸图片幻灯片

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