危急重症患者凝血功能障碍机制及研究进展  

Mechanisms and research advances in coagulation dysfunction in critically ill patients.

作　　者：柳舟[1] 张亮[2] 陈静[3] 李光[1] 邹捍东[1] 朱燚 高航 詹丽英[1] LIU Zhou;ZHANG Liang;CHEN Jing;LI Guang;ZOU Han-dong;ZHU Yi;GAO Hang;ZHAN Li-ying(Intensive Care Unit,Department of Radiology,Wuhan 430060,Hubei,CHINA;Intensive Care Unit,Department of Emergency,Wuhan 430060,Hubei,CHINA;Intensive Care Unit,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,CHINA)

机构地区：[1]武汉大学人民医院重症医学科,湖北武汉430060 [2]武汉大学人民医院放射科,湖北武汉430060 [3]武汉大学人民医院急诊科,湖北武汉430060

出　　处：《海南医学》2025年第8期1210-1216,共7页Hainan Medical Journal

基　　金：国家重点研发计划(编号:2021YFC2501800);武汉大学人民医院交叉创新人才项目(编号:JCRCYG-2022-005)。

摘　　要：危重症患者如急慢性肝功能衰竭、肾功能衰竭、脓毒症、严重创伤、急性中毒等常常面临严重凝血功能障碍。研究表明50%的危重症患者均存在不同程度的凝血功能障碍,16%的危重患者表现为不同程度出血,20%的危重患者伴随原发性或继发性血小板减少,30%的危重患者合并静脉栓塞,包括深静脉血栓甚至急性肺栓塞等。危重患者凝血功能障碍机制各不相同,主要包括:凝血因子/抗凝因子失衡、血小板聚集功能障碍、纤溶系统异常、血管内皮损伤以及病理性抗凝物质增多。无论合并出血性疾病或栓塞性疾病,凝血功能异常均是ICU隐匿的杀手。本文通过分析肝衰竭、肾衰竭以及脓毒症等ICU常见危重患者凝血紊乱病理生理机制,采用规范化监测以及治疗策略,及时去除病因,纠正凝血功能异常,预防凝血紊乱相关不良事件,降低死亡风险,改善临床结局。Critically ill patients,such as those with acute or chronic liver failure,renal failure,sepsis,severe trauma,and acute poisoning,often face severe coagulation dysfunction.Studies have shown that 50%of critically ill pa-tients exhibit varying degrees of coagulation dysfunction,with 16%experiencing bleeding,20%presenting with primary or secondary thrombocytopenia,and 30%developing venous thromboembolism,including deep vein thrombosis and acute pulmonary embolism.The mechanisms of coagulation dysfunction in critically ill patients are diverse and primari-ly include imbalances in coagulation/anticoagulation factors,platelet aggregation dysfunction,abnormalities in the fibri-nolytic system,vascular endothelial injury,and increased pathological anticoagulants.Whether associated with bleeding or thrombotic disorders,coagulation dysfunction is a hidden threat in the ICU.This article analyzes the pathophysiologi-cal mechanisms of coagulation disorders in common critical conditions such as liver failure,renal failure,and sepsis.By adopting standardized monitoring and treatment strategies,timely removal of causative factors,correction of coagulation abnormalities,and prevention of coagulation-related adverse events,the risk of mortality can be reduced,and clinical out-comes improved.

关 键 词：重症医学 凝血功能障碍 脓毒症 病理生理 研究进展 

分 类 号：R605.97[医药卫生—急诊医学]