颅脑创伤急性期凝血功能障碍诊治专家共识(2024版)  

Expert consensus on the diagnosis and treatment of coagulation disorders in the acute phase of traumatic brain injury(version 2024)

作　　者：袁强[1] 虞剑[1] 陈建[2] 陈文劲[3] 丁天凌[1] 方文华[4] 冯军峰[5] 高国一 高亮[7] 杭春华 贺晓生 胡荣 胡颖红[11] 黄齐兵[12] 江荣才[13] 蓝胜勇[14] 李立宏 李育[16] 刘劲芳[17] 马驰原 马辉[19] 毛青[5] 帕珠 任学芳[1] 石广志[6] 苏作鹏 苏忠周[22] 孙晓川[23] 王玉海[24] 王中[25] 魏俊吉[26] 徐福林[21] 许汪斌[27] 张立平[28] 张云东 周建新 王之敏 周强 陈菊祥 李强[28] 冯光[34] 孙晓欧[25] 孙成法 王加充 吕胜青 侯立军 杜倬婴[1] 吴刚[1] 胡锦[1] 国家创伤医学中心颅脑创伤专业委员会 中国医师协会神经外科医师分会神经重症专家委员会 Yuan Qiang;Yu Jian;Chen Jian;Chen Wenjin;Ding Tianling;Fang Wenhua;Feng Junfeng;Gao Guoyi;Cao Liang;Hang Chunhua;He Xiosheng;Hu Rong;Hu Yinghong;Huang Qibing;Jiang Rongcai;Lan Shengyong;Li Lihong;Li Yu;Liu Jinfang;Ma Chiyuan;Ma Hui;Mao Qing;Pa Zhu;Ren Xuefang;Shi Cuangzhi;Su Zuopeng;Su Zhongzhou;Sun Xiaochuan;Wang Yuhai;Wang Zhong;Wei Junji;Xu Fulin;Xu Wangbin;Zhang Liping;Zhang Yundong;Zhou Jianxin;Wang Zhimin;Zhou Qiang;Chen Juxiang;Li Qiang;Feng Guang;Sun Xiaoou;Sun Chengfa;Wang Jiachong;Lyu Shengqing;Hou Lijun;Du Zhuoying;Wu Gang;Hu Jin;Neurotrauma Committee of the National Trauma Center;Neurocritical Care Expert Committee of Branch of Neurological Surgeons of Chinese Medical Doctor Association(Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Affiliated Hospital of Nantong University,Nantong 226006,China;Xuanwu Hospital of Capital Medical University,Beijing 100053,China;First Affiliated Hospital of Fujian Medical University,Fuzhou 350004,China;Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Beijing Tiantan Hospital of Capital Medical University,Beijing 100050,China;Affiliated Tenth People's Hospital of Tongji University,Shanghai 200072,China;Nanjing Drum Tower Hospital Affiliated to Nanjing University School of Medicine,Nanjing 210008,China;Xijing Hospital of Air Force Medical University,Xi'an 710032,China;First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Qilu Hospital of Shandong University,Jinan 250063,China;Tianjin Medical University General Hospital,Tianjin 300052,China;Guangxi Zhuang Autonomous Region People's Hospital,Nanning 530021,China;Tangdu Hospital of Air Force Medical University,Xi'an 710038,China;Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830001,China;Xiangya Hospital of Central South University,Changsha 410008,China;General Hospital of Eastern Theater Command of PLA,Nanjing 210007,China;Ningxi

机构地区：[1]复旦大学附属华山医院,上海200040 [2]南通大学附属医院,南通226006 [3]首都医科大学宣武医院,北京100053 [4]福建医科大学附属第一医院,福州350004 [5]上海交通大学医学院附属仁济医院,上海2200127 [6]首都医科大学附属北京天坛医院,北京100050 [7]同济大学附属第十人民医院,上海200072 [8]南京大学医学院附属鼓楼医院,南京210008 [9]空军军医大学西京医院,西安710032 [10]陆军军医大学第一附属医院,重庆400038 [11]浙江大学医学院附属第二医院,杭州1310009 [12]山东大学齐鲁医院,济南250063 [13]天津医科大学总医院,天津300052 [14]广西壮族自治区人民医院,南宁530021 [15]空军军医大学唐都医院,西安710038 [16]新疆维吾尔自治区人民医院,乌鲁木齐830001 [17]中南大学湘雅医院,长沙410008 [18]中国人民解放军东部战区总医院,南京210007 [19]宁夏医科大学总医院,银川750003 [20]日喀则人民医院,日喀则8857012 [21]复旦大学附属闵行医院,上海201199 [22]湖州市中心医院,湖州313099 [23]重庆医科大学第一附属医院,重庆400016 [24]中国人民解放军联勤保障部队第九○四医院,无锡214004 [25]苏州大学附属第一医院,苏州215006 [26]北京协和医院,北京100730 [27]昆明医科大学第一附属医院,昆明650032 [28]兰州大学第二医院,兰州730030 [29]重庆医科大学附属第三医院,重庆401120 [30]首都医科大学附属北京世纪坛医院,北京100089 [31]苏州市独墅湖医院,苏州215004 [32]苏州九龙医院,苏州215127 [33]海军军医大学第一附属医院,上海200433 [34]河南省人民医院,郑州450003 [35]南通大学附属常熟医院,常熟215513 [36]海口市人民医院,海口570208 [37]陆军军医大学第二附属医院,重庆400037 [38]海军军医大学第二附属医院,上海200070 [39]不详

出　　处：《中华创伤杂志》2024年第4期310-322,共13页Chinese Journal of Trauma

基　　金：上海申康医院发展中心市级医院诊疗技术推广及优化管理项目(SHDC22023224,SHDC22022210);海南省院士创新平台基金(YSPTZX202033)。

摘　　要：颅脑创伤急性期凝血功能障碍高发,显著增加颅内进展性出血及术中大出血风险、救治难度及患者病死率。颅脑创伤后大量组织因子暴露导致凝血异常激活是颅脑创伤急性期凝血功能障碍的主要病理机制,是一种特殊类型的创伤性凝血病。目前,颅脑创伤急性期凝血功能障碍起病隐匿、出现时往往不合并大出血、诊断标准不一、诊治不规范,尚缺乏相关共识或指南。为此,国家创伤医学中心颅脑创伤专业委员会和中国医师协会神经外科医师分会神经重症专家委员会组织国内相关专家,参考国内外相关领域最新指南、共识和临床研究,通过改良德尔菲法征集专家建议,共同制订《颅脑创伤急性期凝血功能障碍诊治专家共识(2024版)》,就颅脑创伤急性期凝血功能障碍的诊断与治疗提出18条推荐意见,旨在规范临床诊治。The high incidence of coagulation disorders in the acute phase after traumatic brain injury significantly increases the risks of progressive intracranial hemorrhage and massive intraoperative bleeding,the difficulty of treatment and the mortality rate of the patients.The main pathological mechanism for coagulation disorders in the acute phase after traumatic brain injury is that a large number of tissue factors become exposed to result in an aberrant activation of coagulation,so it is a special type of trauma-induced coagulopathy.Coagulation disorder in the acute phase after traumatic brain injury has an insidious onset that is often not associated with massive bleeding,leading to non-standardized diagnosis and treatment.Currently,there is a lack of relevant consensus or guideline.For this purpose,Neurotrauma Committee of the National Trauma Center and Neurocritical Care Expert Committee of Branch of Neurological Surgeons of Chinese Medical Doctor Association have organized relevant domestic experts to jointly formulate Expert consensus on the diagnosis and treatment of coagulation disorders in the acute phase of traumatic brain injury(version 2024)with reference to the latest guidelines,consensuses,and clinical researches in relevant fields at home and abroad and expert advice collected through the modified Delphi method.Eighteen recommendations have been proposed for the diagnosis and treatment of coagulation disorders in the acute phase of traumatic brain injury,aiming to standardize its diagnosis and treatment in the clinical settings.

关 键 词：脑损伤 颅内出血 创伤 凝血功能障碍 

分 类 号：R651.15[医药卫生—外科学]