摘要
脓毒症患者大多存在出凝血障碍,严重程度不同。由于促凝物质增多、生理性抗凝物质减少、纤溶相对抑制,体内呈高凝状态,因此脓毒症出凝血障碍是血栓形成型。脓毒症病情不同时期,凝血活化程度不同,需要结合患者临床表现、实验室指标、器官功能等综合评价。多数脓毒症患者在入住重症监护病房时已经错过了早期“免疫血栓”阶段,且凝血活化血栓形成是其他器官功能障碍的始动因素,因此早期识别、早期抗凝治疗就显得更加重要。目前合适的抗凝时机、适合的人群、合适的药物均存在争议,重组人血栓调节蛋白和肝素可能成为有效药物,仍需要大样本随机对照研究提供证据。脓毒症是临床综合征,单一方面治疗很难降低病死率,需要综合评估和集束化治疗。抗凝治疗方面,着眼于出凝血功能的改善或者器官功能的改善,可能更符合抗凝的目标。
Coagulation abnormalities occur in almost all septic patients with different degree of severity.The coagulation activation in sepsis is a thrombotic phenotype due to hypercoagulability caused by increased procoagulant substances,decreased anticoagulant substances and relatively inhibited fibrinolysis.In different stages of sepsis,the degree of coagulation activation is different,which requires comprehensive evaluation based on the clinical manifestations,laboratory indicators and organ functions of septic patients.Most sepsis patients have missed the early stage called"immunothrombosis"when admitted to intensive care unit.Since thrombosis in sepsis is the initiating factor of other organ dysfunction,early identification and early anticoagulant therapy are important.At present,the appropriate timing,proper patients,and suitable anticoagulants are all controversial.Recombinant human thrombomodulin and heparin seem to be promising drugs.Large randomized controlled trials are needed to provide evidence.Sepsis is a clinical syndrome and it is difficult to reduce the mortality with single treatment.Therefore,comprehensive evaluation and bundled treatment are essential.Anticoagulant therapy that focuses on the improvement of coagulation or organ function,may be the goal of anticoagulation in sepsis.
作者
李旭
马晓春
LI Xu;MA Xiao-chun(Department of Critical Care Medicine,the First Affiliated Hospital,China Medical University,Shenyang 110001,China)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2021年第6期466-469,474,共5页
Chinese Journal of Practical Internal Medicine
基金
国家自然科学基金(81671936)。
关键词
脓毒症
凝血活化
抗凝治疗
sepsis
coagulation activation
anticoagulant therapy
