脓毒症凝血功能障碍中西医结合诊治专家共识OA

Sepsis-induced coagulopathy(SIC)is a common and important complication of sepsis and is closely associated with organ dysfunction and death.It is a dynamic process that may progress from inflammation-driven hypercoagulability to disseminated intravascular coagulation(DIC)and consumptive hypocoagulability.As current international guidelines provide no explicit recommendations for integrated traditional Chinese Medicine and Western medicine in SIC,standardized diagnosis and treatment strategies remain limited in China.This consensus document was developed by the Critical Care Medicine Branch of the Shanghai Medical Association and the Disaster Medicine Professional Committee of Integrated Chinese and Western Medicine Association,employing a modified Delphi method to systematically analyze clinical issues based on the population,intervention,comparison,outcome,study design(PICOS)framework,and utilizing the grading of recommendations assessment,development and evaluation(GRADE)system to assess the quality of evidence and the strength of recommendations.The consensus proposes the following recommendations:implement a"two-step approach"utilizing the International Society on Thrombosis and Hemostasis(ISTH)SIC scoring system and the overt DIC scoring system for early identification and staging of SIC;incorporate dynamic monitoring of thromboelastography(TEG)or rotational thromboelastometry(ROTEM)alongside conventional coagulation tests to assist in identifying the transition from hypercoagulability to consumptive hypocoagulability;guide treatment based on the dynamic pathogenesis framework of"toxicity-stasis-deficiency"integrating therapeutic strategies such as clearing heat and detoxifying,cooling the blood and dispersing stasis,promoting blood circulation and resolving stasis,replenishing qi and stabilizing collapse,and facilitating internal clearance,tailored to specific syndromes such as intense heat-toxicity,interaction of toxicity and stasis,sudden collapse of yang qi,depletion of qi and yin,and obstruction of fu-qi;establish a multidisciplinary team(MDT)comprising both Chinese and Western medical experts centered around the department of critical care medicine,with enhanced monitoring of therapeutic efficacy and safety.Current evidence from traditional Chinese medicine research predominantly consists of single-center,small-sample studies;therefore,future research should focus on multicenter,high-quality studies with SIC staging and clinically important outcomes as prespecified primary endpoints.This consensus aims to provide a standardized and practical clinical reference for the integrated traditional Chinese and Western medicine approach to the diagnosis and treatment of SIC.