创伤性凝血病病理生理及诊治的研究进展

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1、授予单位代码10089学号或申请号10010010017中国图书分类号R641硕士学位论文专业学位创伤性凝血病病理生理及诊治的研究进展研究生:沈哲源导师:彭阿钦教授专业:外科学二级学院:第三医院2018年3月目录中文摘要···············································································1英文摘要···········································································

2、····2综述创伤性凝血病病理生理及诊治的研究进展····························3参考文献···············································································13致谢·····················································································21个人简历·····································

3、··········································22中文摘要创伤性凝血病病理生理及诊治的研究进展摘要创伤性凝血病（TIC）指创伤后由于大出血和组织损伤而激活凝血、纤溶和抗凝途径，出现的急性凝血功能紊乱。这一现象是创伤后低体温、酸中毒、血液稀释、组织灌注不足、组织损伤等原因所导致。诊断TIC主要依靠传统的凝血功能分析以及血栓弹力图（TEG）。目前，治疗TIC的关键是迅速止血。按合适比例输注红细胞压积和新鲜冰冻血浆，及时输注血小板和促凝物质来稳定血压及重建凝血机制是治疗的基本步骤。本文总结了近年有关T

4、IC的病理生理机制及治疗方案的最新进展，以期为相关领域的深入研究提供参考。关键词：创伤性凝血病，凝血障碍，低体温，酸中毒，血液稀释，休克，复苏1英文摘要TraumaticInducedCoagulopathy：PathophysiologyDiagnosisAndTherapyABSTRACTTraumainducedcoagulopathy（TIC）isanacutecoagulopathyinwhichcoagulation,fibrinolysisandanticoagulantpathwaysareactivatedafte

5、rtraumaduetomassivehemorrhageandtissuedamage.Thisphenomenoniscausedbyhypothermia,acidosis,blooddilution,hypoperfusion,tissueinjury,etc.TodiagnoseTIC,wemainlyrelyontraditionalcoagulationfunctionanalysisandthrombelastogram(TEG).Atpresent,thekeytotreatTICishemostasis.Tran

6、sfusionofpackedredbloodcellsandfreshfrozenplasmabyappropriateproportion,infusionofplateletsandsupplementscoagulantmaterialintimetostabilizebloodpressureandreconstructthebloodcoagulationmechanismisthebasicsteps.Inthispaper,wereviewedrecentadvancesinthepathophysiological

7、andtreatmentofTICinordertoprovidereferencesforfurtherresearchinrelatedfields.Keywords:TraumaticInducedCoagulopathy,Coagulopathy,hypothermia,Acdiosis,Hemodilution,Shock,Resuscitation2综述创伤性凝血病病理生理及诊治的研究进展创伤是一累及全球的公共卫生问题。就全世界范围来说，它已成为继心脏病和肿瘤疾病之后的第三大致死原因。到2020年，创伤则将成为第二大致死

8、原因。外伤后因难以控制的出血而死亡的患者占死亡总数的30%~40%[1]。创伤性凝血病（traumainducedcoagulopathy，TIC）是指创伤后由于患者大量失血和组织损伤而激活机体的凝血、纤溶和抗凝途径，出现的急性凝血功