中国中西医结合急救杂志2026，Vol.33Issue(4)：385-396,12.DOI:10.3969/j.issn.1008-9691.2026.04.001
脓毒症凝血功能障碍中西医结合诊治专家共识
Expert consensus on diagnosis and treatment of sepsis-induced coagulopathy with intergrated traditional Chinese medicine and Western medicine
摘要
Abstract
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.关键词
脓毒症/脓毒症凝血功能障碍/弥散性血管内凝血/中西医结合/专家共识Key words
Sepsis/Sepsis-induced coagulopathy/Disseminated intravascular coagulation/Integrated traditional Chinese and Western medicine/Expert consensus引用本文复制引用
上海市医学会危重病专科分会,上海市中西医结合学会灾害医学专业委员会,潘婷婷,钟鸣,瞿洪平..脓毒症凝血功能障碍中西医结合诊治专家共识[J].中国中西医结合急救杂志,2026,33(4):385-396,12.基金项目
新发突发与重大传染病防控国家科技重大专项(2025ZD01903000) （2025ZD01903000）
上海市级医院中西医协同引导项目(ZXXT-202401) National Science and Technology Major Project on Prevention and Control of Majar-Infectious Diseases(2025ZD01903000) （ZXXT-202401）
Shanghai Municipal Hospital Program for Coordinated Traditional Chinese and Western Medicine(ZXXT-202401) （ZXXT-202401）
