急性创伤性凝血功能障碍的发生机制及诊断  

Acute traumatic coagulopathy:mechanisms and diagnosis

作　　者：张勇骁 刘善收 代铮 付传庆 尹文 ZHANG Yongxiao;LIU Shanshou;DAI Zheng;FU Chuanqing;YIN Wen(Department of Emergency,the First Affiliated Hospital of Air Force Medical University,Xi'an,Shaanxi 710032,China)

机构地区：[1]空军军医大学第一附属医院急诊科,陕西西安710032

出　　处：《中华全科医学》2025年第3期472-476,共5页Chinese Journal of General Practice

基　　金：国家自然科学基金项目(82372190);军队后勤科研重点项目(BWS21J002)。

摘　　要：创伤诱导的凝血功能障碍(trauma induced coagulopathy,TIC)是由创伤引起的异常凝血过程。早期表现为凝血不足导致出血,后期以高凝状态为特征,与静脉血栓栓塞(venous thromboembolism,VTE)和多器官功能衰竭(multiple organ failure,MOF)相关。TIC的病理机制复杂,包括内皮功能障碍、免疫系统激活、血小板功能异常及凝血激活,在“致命三联征”(凝血障碍、低体温、酸中毒)下更加明显。实验室诊断主要基于传统凝血功能检测和黏弹性止血检测。近年来,细胞介导的止血模型得到广泛关注,强调了血小板和内皮细胞的关键作用。组织损伤和失血性休克(hemorrhagic shock)导致的代谢异常与TIC密切相关。纤溶系统失衡可能增加出血或血栓形成风险。TIC管理的优先事项是止血和恢复循环血容量。目标导向的血液制品输注策略和抗纤溶药物如氨甲环酸的应用显示出良好效果。新研究方向包括微RNA(microRNA)调控、内皮糖萼层损伤与TIC的关系,以及个体化精准治疗策略的开发。本文综述了TIC的机制、诊断和治疗进展,为急性创伤性凝血功能障碍的认识和管理提供方向。Trauma induced coagulopathy(TIC)is defined as an abnormal coagulation process caused by trauma.The condition initially presents as insufficient coagulation,leading to bleeding;a state that is later characterized by hypercoagulability,with associated venous thromboembolism(VTE)and multiple organ failure(MOF).TIC's complex pathophysiology involves endothelial dysfunction,immune system activation,which are platelet dysfunction,and coagulation activation,exacerbated by the"lethal triad"(coagulopathy,hypothermia,acidosis).The primary focus of laboratory diagnosis is on conventional coagulation tests and viscoelastic hemostatic assays.However,recent emphasis on cell-mediated hemostasis models has underscored the pivotal roles of platelets and endothelial cells.Moreover,it is noteworthy that metabolicit is noteworthy that metabolic abnormalities induced by tissue damage and hemorrhagic shock are closely associated with TIC.Imbalanced fibrinolytic systems have been demonstrated to engender heightened risks of both bleeding and thrombosis.The management of TIC is predicated on two fundamental objectives:the primary one being the cessation of bleeding,and the secondary one being the restoration of blood volume.Goal-directed transfusion strategies of blood products,in conjunction with antifibrinolytic drugs such as tranexamic acid,have been shown to yield encouraging results.Emerging research areas include microRNA regulation,the relationship between endothelial glycocalyx damage and TIC,and the development of individualized precision treatment strategies.This review summarizes the mechanisms of tissue injury(TIC),the diagnosis and treatment advances,and provides insights for understanding and managing acute traumatic coagulopathy.

关 键 词：急性创伤性凝血障碍 失血性休克 大量输血 纤维蛋白溶解 目标导向复苏 静脉血栓栓塞 

分 类 号：R641[医药卫生—外科学] R554[医药卫生—临床医学]