Management of coagulopathy:
Intraoperative and postoperative management of
potential or actual coagulopathy includes: (1) visual assessment of the surgical field and
laboratory monitoring for coagulopathy, (2) transfusion of platelets, (3) transfusion of freshfrozen
plasma, (4) transfusion of cryoprecipitate, (5) administration of drugs to treat excessive
bleeding (e.g., desmopressin, topical hemostatics), and (6) recombinant activated factor VII.
Visual assessment of the surgical field is standard practice and entails assessments of the
presence of microvascular bleeding and the extent of blood present. Laboratory monitoring
includes point-of-care intraoperative or postoperative assessments. In a bleeding patient,
obtaining coagulation tests is also standard practice, and the literature suggests that coagulation
test results correlate with perioperative blood loss, depending on the type of fluid used for
intravascular volume replacement. The literature supports the use of desmopressin and topical
hemostatics to treat excessive bleeding. Although there are insufficient numbers of published
clinical trials assessing the efficacy of recombinant activated factor VII in treating excessive
microvascular bleeding (i.e., coagulopathy), multiple case reports indicate its efficacy as a rescue
drug when standard therapy has failed.
凝血障碍的处理
术中或术后凝血障碍处理包括:(1)肉眼评估手术野和检测凝血指标;(2)输注血小板;(3)新鲜冰冻血浆(FFP)输注;(4)冷沉淀输注;(5)使用药物治疗大失血(如去氨加压素、表面止血剂);(6)重组活化Ⅶ因子。
肉眼评估手术野是一种标准方法,而且也是评价微血管出血和失血量所必需。实验室监测包括术中或术后床旁评估。失血病人的凝血检查也是标准的方法,文献提示凝血检测结果与围手术期失血相关,它取决于血管内扩容量所用的液体种类。文献支持使用去氨加压素和表面止血剂治疗大量出血。虽然还没有足够量的已发表的临床研究证明重组活化Ⅶ因子治疗微血管出血有效,但许多个案报告了在标准治疗失败后它是有效的急救药物。 |