监测出血过程中的血液凝固情况

A. Ahmed
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摘要

背景。出血和血栓事件的风险应在手术前、手术中和手术后进行权衡。为了方便这个过程,建议问自己以下问题:如果我们现在开始手术,出血会发展吗?如果我们延迟干预,会发生血栓事件吗?患者的抗血栓药物是否有效?目标。介绍了血凝监测系统。材料和方法。对这一主题的文献来源进行分析。结果和讨论。凝血功能障碍可以是先天性的也可以是后天的,后者包括医源性的。先天性凝血病的病因包括血友病、血管性血友病因子缺乏症、血小板减少症和抗磷脂综合征。抗血小板药物和直接口服抗凝剂是医源性凝血病的主要原因。获得性凝血功能障碍的其他原因包括止血失败、弥散性血管内凝血综合征和各种类型的术后凝血功能障碍。为了治疗凝血疾病出血,给予去氨加压素、氨甲环酸、凝血因子和鱼精蛋白。检测凝血功能障碍所需的实验室检查包括凝血酶原时间、活化的部分凝血活酶时间、凝血酶时间、国际标准化比率、纤维蛋白原水平和凝血因子。这些测试的局限性包括它们的非动态性,缺乏预测出血风险的能力,时间和经济成本,无法了解出血的病理生理机制。由于样品中添加了柠檬酸盐和钙,分析中也可能出现误差。评估止血系统的快速测试包括测定活化凝血时间、Hepcon肝素监测系统、血栓弹性成像和血小板制图、使用多个电极的血小板聚集、旋转血栓弹性测量和超声测量。结论:1。为获得最佳效果,凝血功能障碍应及时预测、检测和治疗。2. 血凝块的强度取决于血小板和纤维蛋白原。3.建议使用快速测试来评估止血,并定期重复,因为出血和凝血是动态的过程。4. 应牢记血液稀释、酸碱平衡和温度的影响。
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Monitoring of blood clotting during bleeding
Background. The risk of bleeding and thrombotic events should be weighed before, during and after surgery. To facilitate this process, it is advisable to ask yourself the following questions: if we start the operation now, will the bleeding develop? If we delay the intervention, will a thrombotic event occur? Are the patient’s antithrombotic drugs effective? Objective. To describe the blood coagulation monitoring system. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Coagulopathy can be congenital and acquired, the latter including iatrogenic. The causes of congenital coagulopathies include hemophilia, von Willebrand factor deficiency, thrombocytopenia, and antiphospholipid syndrome. Antiplatelet drugs and direct oral anticoagulants are the main causes of iatrogenic coagulopathies. Other causes of acquired coagulopathies include hemostasis failure, disseminated intravascular coagulation syndrome, and post-surgical coagulopathies of various types. In order to treat bleeding in coagulopathies, desmopressin, tranexamic acid, coagulation factors, and protamine are administered. Laboratory tests needed to detect coagulopathies include prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, fibrinogen levels, and coagulation factors. The limitations of these tests include their non-dynamic nature, lack of ability to predict the risk of bleeding, time and financial costs, inability to understand the pathophysiological mechanism of bleeding. There may also be an error in the analysis due to the addition of citrate and calcium to the samples. Rapid tests to assess the hemostasis system include determination of activated coagulation time, Hepcon heparin monitoring system, thromboelastography and platelet mapping, platelet aggregometry using multiple electrodes, rotational thromboelastometry, and sonoreometry. Conclusions. 1. For best results, coagulopathy should be anticipated, detected, and treated in a timely manner. 2. The strength of blood clots depends on platelets and fibrinogen. 3. It is advisable to use rapid tests to assess hemostasis and repeat them regularly, as bleeding and blood clotting are dynamic processes. 4. The effects of hemodilution, acid-base balance and temperature should be kept in mind.
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