急性创伤性凝血病与创伤复苏治疗

由创伤引起的急性剖伤性凝血病可发生于创伤早期，通常仅见于休克患者。凝血病产生不可控制的失血是严重创伤的主要死亡原因。关键在患者入院当初，早期发现创伤性凝血病。创伤性凝血病的启动因素可能是组织低灌注引发蛋岛C——凝血酶调节蛋白系统过度活化，产生全身性抗凝和原发性纤溶亢进，从而加大失血量，加重出血性休克。最后导致器官功能衰竭和高病死率。因此，急性创伤性凝血病治疗的焦点在于缩短休克期和低灌注状态。要纠正严重创伤伴发的“致命性三联征”。特别对于微血管出血尚未被制止的严重创伤患者，宜积极输入新鲜血浆、浓缩血小板及冷沉淀物。防止不恰当地应用大量输晶体液，或库存血，或蕊缩红细胞液。在大量失血情况下，输注新鲜全血比成分输血更有优越性。重组活化FVII是促进凝血酶生成的强效药物，需要避一步明确其适应证及局限性。

Acute Traumatic Coagulopathy and Trauma Resuscitation

Acute traumatic coagulopathy secondary to severe trauma may develop during the early phase, and only in patients with shock. Uncontrolled coagulopathic hemorrhage is the major cause of death following major trauma. The recognition of the traumatic coagulopahy at the time of admission is critical. Acute traumat）c coagulopathy is primarily caused by tissue hypoperfusion resulting in activation of the protein C-thrombomodulin pathway and systemic anticoagul ation,associated with primary hyperfibrinolysis.This would contribute to increase blood loss and exacerbate shock state,leading to an increased incidence of organ failure and a high mortality, Therefore,the management of the acute traumatic coagulopathy should focus on limiting the duration of shock and tissue hypoperfusion. The trauma-associated ＂Lethal Triad＂, should be corrected as quickly as possible.More aggressive use of frozen fresh plasma（FFP）,concentrate of platelets（PLTs）and cryoprecipitate is seriously recommended in severely injured patients,especially if microvascular bleeding is not stopped. Warning against the inappropriate use of high volume crystalloids,stored bank blood, or packed red blood cells（PRBCs）. In case od massive hemorrhage,the use of fresh whole blood may be beneficial compared to component transfusion for trauma resuscitation. The recombinant activated FVIl（rFVIla）is a potent drug due to its ability to increase thrombin generation. Further research is required to define more clearly the indications and limitations of it efficacy.