ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－360－LS7Department of Surgery, Division of Acute Care Surgery, The University of Texas, USABryan CottonAmong those patients arriving to major trauma centers, 20-40% present with evidence of the acute coagulopathy of trauma（ACoT）. Compared to patients without admission coagulopathy, those with ACoT have up to a 300% increased risk of mortality.Recent studies have demonstrated that patients die from hemorrhage（or hemorrhage and coagulopathy is controlled）within 3hours of admission. Rapid identification and immediate treatment of ACoT is critical. Unfortunately, most coagulation testingfocuses on a single part of cascade, are run on “spun-down” plasma only samples, and were never designed to assesscoagulopathy following injury or surgery. In addition, results are often flawed due to the differences in lab and clinicalenvironment. There is also concern of the lag time inherent in drawing blood, processing, and obtaining results.Viscoelastic testing is run on whole blood samples, captures multiple components on the clotting cascade, and their results canbe visualized in real-time, allowing one to act on the values immediately. Rapid thrombelastography evaluates clot initiation andthrombin generation（ACT, k-time）, clot acceleration and fibrinogen function（alpha）, platelet function（mA）and fibrinolysis（LY30）. Within minutes of arrival, r-TEG has been shown to predict blood and blood component transfusions in the first hoursof resuscitation.Fibrinolysis as determined by r-TEG can also help guide anti-fibrinolytic therapy. Used as part of a clinical practice guideline,several centers have replaced conventional coagulation tests with r-TEG and use these to guide their acute resuscitations ofseverely injured and critically ill patients. These changes appear to more rapidly correct coagulopathy in these patients, while atthe same time reduce overall transfusions. These data appear to be reproducible in injured children as well. Finally, viscoelastictesting appears equally as impressive in predicting post-operative and post-injury thromboembolic events, including deep venousthrombosis, pulmonary embolism, vascular graft occlusion, myocardial infarctions and stroke. Elevated fibrinogen（alpha）andplatelet function（mA）appear able to identify those patients at highest risk upon admission from injury or immediately postoperatively.ランチョンセミナー 7 2月12日（金）　12：20～13：20　第8会場Improvement of patient outcome by the use of coagulation testing in the acute coagulopathy of trauma（ACoT）