凝血病
纤溶亢进
创伤性脑损伤
医学
弥漫性血管内凝血
重症监护医学
发病机制
病理生理学
免疫学
内科学
精神科
出处
期刊:Transfusion
日期:2013-01-01
卷期号:53 (S1)
被引量:132
摘要
Coagulopathy after traumatic brain injury ( TBI ) is frequent and represents a powerful predictor related to outcome and prognosis. The complex pathophysiological mechanisms of the coagulopathy of TBI are multifactorial and remain still undefined. The nature of the coagulation abnormalities differs between severe TBI and non‐ TBI with somatic injuries. The current hypothesis for the development of coagulopathy after TBI includes combinations of both hypo‐ and hypercoagulable states promoted by the magnitude and the extent of the injury resulting in a variable degree of secondary injury via subsequent ischemic and hemorrhagic lesioning. The proposed underlying mechanisms may comprise the release of tissue factor ( TF ), hyperfibrinolysis, shock, and hypoperfusion thus triggering the protein C pathway, disseminated intravascular coagulation, and platelet dysfunction. Hemocoagulative disorders after TBI may be amenable to treatment, and adequate and timely management may protect from secondary injury and poor outcomes. Functional assays such as viscoelastic tests may be supportive in early detection, diagnosis, and guidance of treatment. This review summarizes the current understanding with regard to frequency, pathogenesis, diagnosis, and treatment of the coagulopathy after TBI .
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