С. Н. Козарезов
УО «Белорусский государственный медицинский университет»
Данный обзор литературы посвящен актуальной проблеме медицины – синдрому диссеминированного внутрисосудистого свертывания. Помимо общей этиологической, клинической и лабораторных характеристик, в статье обобщены современные подходы к диагностике и лечению синдрома диссеминированного внутрисосудистого свертывания. С точки зрения патофизиологии охарактеризованы основные варианты течения синдрома. Представлены рекомендации, касающиеся диагностики и лечения патологического процесса, разработанные субкомитетом по синдрому диссеминированного внутрисосудистого свертывания научного и стандартизационного комитета международного общества тромбоза и гемостаза на основании трех руководств (Британского комитета по стандартам в гематологии, Японского общества тромбоза и гемостаза и Итальянского общества тромбоза и гемостаза). Помимо разработанной международным обществом тромбоза и гемостаза в 2001 году и актуальной до настоящего времени балльной системы диагностики явного, описана модифицированная система для диагностики скрытого, а также упрощенная балльная система Японского общества тромбоза и гемостаза для диагностики сепсис-ассоциированного синдрома диссеминированного внутрисосудистого свертывания. Приведены актуальные к настоящему моменту рекомендации по применению свежезамороженной плазмы, факторов свертывания, тромбоцитарной массы, антикоагулянтов, концентратов факторов противосвертывающей системы и препаратов с антифибринолитической активностью.
ключевые слова: синдром диссеминированного внутрисосудистого свертывания, диагностика, лечение
Modern approaches to diagnosis and treatment of disseminated intravascular coagulation
S. N. Kozarezov
This review of the literature is devoted to the actual problem of medicine – disseminated intravascular coagulation. In addition to the general etiological, clinical and laboratory characteristics, the article summarizes the current approaches to the diagnosis and treatment of disseminated intravascular coagulation. From the point of view of pathophysiology, the main variants of the syndrome have been characterized. Recommendations for diagnosis and treatment of the pathological process developed by the subcommittee for disseminated intravascular coagulation of the Scientific and Standardization Committee of the International Society of Thrombosis and Hemostasis based on three guidelines (British Committee for Standards in Haematology, the Japanese Society of Thrombosis and Hemostasis, and the Italian Society for Thrombosis and Hemostasis) are provided. In addition to the International Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation scoring system, modified non-overt disseminated intravascular coagulation diagnostic criteria, and the simplified modification of Japanese Society of Thrombosis and Hemostasis diagnostic criteria for sepsis-associated disseminated intravascular coagulation are described. The current recommendations for the use of fresh frozen plasma, coagulation factors, platelets, anticoagulants, anticoagulant factor concentrates, and antifibrinolytic treatment are given.
keywords: disseminated intravascular coagulation, diagnosis, treatment
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