Аннотация
Список литературы
Основной причиной летальных исходов при травмах, больших оперативных вмешательствах является приобретенная коагулопатия, возникающая вследствие массивных повреждений тканей, острой кровопотери, неадекватной заместительной терапии. Статья посвящена обзору патогене-за коагулопатии, возникающей при острой кровопотере и гемодилюции. Рассмотрены механизмы нарушения гемостаза, влиянии гемодиюции на свертывание крови, основные методы диагностики коагулопатии при острой кровопотере, приведены методы коррекции, возникающих нарушений, с современными рекомендациями заместительной терапии.
Ключевые слова:
коагулопатии, гемодилюция, острая кровопотеря
Coagulopathy after massive hemorrage and hemodilution
Fluid resuscitation after massive hemorrhage in major surgery and trauma may result in extensive hemodilution and coagulopathy, which is of a multifactorial nature. Although coagulopathy is often perceived as hemorrhagic, extensive hemodilution affects procoagulants as well as anticoagulant, profibrinolytic, and antifibrinolytic elements, leading to a complex coagulation disorder.
Keywords
coagulopathy, hemodilution, massive hemorrhage
- 1. Bolliger, D., Szlam F., Levy J.H. et al. Haemodilution-induced profibrinolytic state is mitigated by fresh-frozen plasma: Implications for early haemostatic intervention in massive haemorrhage / / Br J Anaesth. - 2010. - №104. - Р.318 -325.
- 2. Bolliger, D., Szlam F., Molinaro R.J. et al. Finding the optimal concentration range for fibrinogen replacement after severe haemodilution: An in vitro model / / Br J Anaesth. - 2009. - №102. -Р.793-799.
- 3. Uitte de Willige S., de Visser M.C., Houwing-Duistermaat J.J. et al. Genetic variation in the fibrinogen gamma gene increases the risk for deep venous thrombosis by reducing plasma fibrinogen gamma' levels// Blood. - 2005. - №106. - Р.4176-4183.
- 4. Martini, W. Z., Holcomb J.B. Acidosis and coagulopathy: The differential effects on fibrinogen synthesis and breakdown in pigs / / Ann Surg. - 2007. - №246. - Р.831-835.
- 5. Collet, J.P., Park D., Lesty C., et al. Influence of fibrin network conformation and fibrin fiber diameter on fibrinolysis speed: Dynamic and structural approaches by confocal microscopy / / Arterioscler Thromb Vasc Biol. - 2000. - №20. - Р.1354-1361. 6. Hathcock, J.J., Nemerson Y. Platelet deposition inhibits tissue factor activity: In vitro clots are impermeable to factor Xa / / Blood. - 2004.- №104. - Р.123-127.
- 7. O'Shaughnessy, D.F., Atterbury C., Bolton Maggs P. et al. British Committeefor Standards in Haematology, Blood Transfusion Task Force: Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant // Br J Haematol. - 2004. - №126. - Р.11-28.
- 8. Rossaint, R., Bouillon B., Cerny V. et al. Management of bleeding following major trauma: An updated European guideline // Crit Care. - 2010. - №14. - Р.52.
- 9. Gerlach, R., T o ' l l e F., Raabe A. et al. Increased risk for postoperative hemorrhage after intracranial surgery in patients with decreased factor XIII activity: Implications of a prospective study // Stroke. - 2002. - №33. - Р.1618-1623.
- 10. Rugeri, L., Levrat A., David JS. et al.: Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography / / J Thromb Haemost. - 2007. - №5. - Р.289-295.
- 11. Grant, P.J. Hormonal regulation of the acute haemostatic response to stress / / Blood Coagul Fibrinolysis.- 1990. - №1. -Р.299 - 306.
- 12. Schochl, H., Nienaber U., Hofer G. et al. Goaldirected coagulation management of major trauma patients using thromboelastometry (ROTEM(R))-guided administration of fibrinogen concentrate and prothrombin complex concentrate / / Crit Care. -2010. - №14. - Р.55.
- 13. Kozek-Langenecker, S.A. Effects of hydroxyethyl starch solutions on hemostasis / / Anesthesiology. - 2005. - №103. - Р.654-660.
- 14. Mittermayr, M., Streif W., Haas T. et al. Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo // Br J Anaesth. - 2008. - №100. - Р.307-314.
- 15. Fries, D., Innerhofer P., Klingler A. et al. The effect of the combined administration of colloids and lactated Ringer's solution on the coagulation system: An in vitro study using thrombelastograph coagulation analysis (ROTEG) / / Anesth A n a l g . - 2002. - №94. -Р.1280-1287.
- 16. Nielsen, V. G. Hydroxyethyl starch enhances fibrinolysis in human plasma by diminishing alpha2-antiplasmin-plasmin interactions / / Blood Coagul Fibrinolysis. - 2007. - №18. - Р.647-656.
- 17. Ruttmann, T.G., James M.F., Finlayson J. Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery / / Br J Anaesth. - 2002. - №89. - Р.226-230.
- 18. Blajchman, M. A., Bordin J. O., Bardossy L. et al. The contribution of the haematocrit to thrombocytopenic bleeding in experimental animals / / Br J Haematol. - 1994. - №86. - Р.347-350.
- 19. Gonzalez, E.A., Moore F.A., Holcomb J.B. et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion / / J Trauma. - 2007. - №62. - Р.112-119.
- 20. Roback, J. D., Caldwell S., Carson J. et al. Evidence-based practice guidelines for plasma transfusion / / Transfusion.- 2010. -№ 5 0 . - Р.1227-1239.
- 21. Stinger, H. K., Spinella P. C., Perkins J. G. et al. The ratio of fibrinogen to red cells transfused affects survival in casualties receiving massive transfusions at an army combat support hospital / / J Trauma. - 2008. - №.64. - Р.79 - 85.
- 22. Lang, T., Johanning K., Metzler H. et al. The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia // Anesth Analg. - 2009. - №108. - Р.751-758.
- 23. Haas, T., Fries D., Velik-Salchner C. et al. Fibrinogen in craniosynostosis surgery / / Anesth Analg. - 2008. - № 1 0 6 . - Р.725-731.
- 24. Gerlach, R., To' lle F., Raabe A. et al. Increased risk for postoperative hemorrhage after intracranial surgery in patients with decreased factor XIII activity: Implications of a prospective study // Stroke. - 2002. - №33. - Р.1618-1623.
- 25. Levy, J.H., Tanaka K.A., Dietrich W. Perioperative hemostatic management of patients treated with vitamin K antagonists // ANESTHESIOLOGY. - 2008. - №109. - Р.918-926.
- 26. Bruce, D., Nokes T.J. Prothrombin complex concentrate (Beriplex P/N) in severe bleeding: Experience in a large tertiary hospital // Crit C a r e . - 2008. - №12. - Р.105.
- 27. Staudinger, T., Frass M., Rintelen C. et al. Influence of prothrombin complex concentrates on plasma coagulation in critically ill patients / / Intensive Care Med. - 1999. - №25. - Р.1105-1110.
- 28. Schochl, H., Nienaber U., Hofer G. et al. Goaldirected coagulation management of major trauma patients using thromboelastometry (ROTEM(R))-guided administration of fibrinogen concentrate and prothrombin complex concentrate / / Crit Care. -2010. - №14. - R 55.
- 29. Spiess, B. D., Royston D., Levy J. H. et al. Platelet transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes / / Transfusion. - 2004. - №44. - Р.1143-1148.
- 30. Shakur, H., Roberts R., Bautista R., et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial / / Lancet. - 2010. - №376. - Р. 23 - 32.