内毒素所致DIC时血小板胞浆Ca^2＋浓度变化的研究

本实验观察内毒素在体外对兔血小板胞浆游离钙浓度[Ca~(2+)]i的作用以及用二次注射内毒素法复制DIC模型时对[Ca~(2+)]i的影响。结果表明静息血小板[Ca~(2+)]i为112±24 nM,内毒素可直接作用于血小板,使[Ca~(2+)]i呈剂量依赖性升高。内毒素致DIG时(Ca~(2+)]i可升高三倍。结果提示内毒素可能是通过升高血小板[Ca~(2+)]i而激活血小板。血小板的激活可能是导致DIC的重要发病机制之一。     

Knochenheilung und dynamischer Interferenzstrom (DIC). —Erste vergleichende tierexperimentelle Studie an Schafen Teil II: Physikalische und chemische Ergebnisse

Zusammenfassung Zusätzlich wurden physikalische und chemische Untersuchungen über den Einfluß von dynamischem Interferenzstrom (DIC) auf die Knochenheilung durchgeführt, nachdem bei 24 Schwarzkopfschafen eine Querosteotomie des Radius vorgenommen worden war. Nach instabiler Osteosynthese wurde die Osteotomiezone wiederholt mit DIC verschiedener mA—Stärken behandelt. (Methodische Einzelheiten sind in Teil I beschrieben). Die Behandlung mit dynamischem Interferenzstrom führte im behandelten Gewebe zu steigenden Temperaturen, die von den mA—Stärken abhängig waren. Weiterhin wurden Zusammenhänge zwischen DIC—mA—Intensität und dem Vorkommen von Hydroxyprolin, einer kollagenspezifischen Aminosäure, nachgewiesen, welches eine erhöhte Calcifizierungsaktivität zur Folge hatte. Messungen des Calcium— und Phosphorgehaltes im neugebildeten Knochengewebe wiesen bei den mit DIC behandelten Tieren vollständige Mineralisation zu einem viel früheren Zeitpunkt als bei den unbehandelten, nach gleichem Verfahren operierten Kontrolltieren auf. Ob DIC einen spezifischen Reiz auf die Knochenneubildung heilender Knochen ausübt, ist noch nicht vollständig geklärt.

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Bone healing and Dynamic Interferential Current (DIC)

Summary In the course of supplementary physical and chemical investigations of the influence ofDynamicInterferential Current (DIC) on bone healing 24 black-head sheep were subjected to transversal osteotomy of the radius. After an instable osteosynthesis the site was exposed to repeated therapy with DIC of varying mA intensity. (Methodological details are described in part 1.) DIC therapy resulted in altering the temperatures in the treated tissue, dependent on the mA intensity. Further associations were verified between DIC intensity and the occurrence of hydroxyprolin, an amino acid specific collagen, which also reflected increased calcifying activity. Measurements of the calcium and phosphorus levels in the regenerated (newly forming) bone tissue documented full mineralization in the DIC-treated animals at a much earlier date than in the untreated controls that had undergone similar operations. Whether DIC specifically stimulates osteogenesis within healing bones is still unclear.

     

重型隐性胎盘早剥致急性DIC 5例临床分析

目的:分析重型隐性胎盘早剥的临床特点及疗效.方法:对5例隐性胎盘早剥患者的妊龄、合并症、孕期、首发症状及并发症等方面进行分析.结果:隐性胎盘早剥在发病初期易被忽略.结论:隐性胎盘早剥是妊娠晚期的一种产科急症,可发生DIC等并发症甚至危及母儿生命.     

D-二聚体检测在产前高凝中的应用

目的 探讨D-二聚体检测在产前高凝状态判断中的意义.方法 通过对420例孕末期妇女进行D-二聚体检测并追踪观测产后临床情况,进行比较分析.结果 >0.5 mg/L时,要尤其注意DIC的危险,特别是>5.0 mg/L,一定要采取治疗措施.结论 对于孕末期妇女检测D-二聚体高于正常值的妇女临床应严加注意.     

Prevalence and Characterization of Thrombocytopenia in Pregnancy in Indian Women

To find the prevalence and causes of thrombocytopenia during pregnancy. An analytical prospective observational study was conducted in Department of Obstetrics & Gynecology, CSMMU, Lucknow. 1079 antenatal women screened for thrombocytopenia and investigated for cause and management strategies and fetomaternal outcome were recorded. Prevalence of thrombocytopenia was 8.8%. Gestational thrombocytopenia was seen in 64.2%, obstetric in 22.1% and medical in 13.68% cases. Mean platelet count in controls was lower with a significant fall (P < 0.001) in the platelet count as pregnancy advanced. Hypertensive and hepatic disorders were the most common obstetric causes of thrombocytopenia. Mode of delivery was not affected by thrombocytopenia. Maternal morbidity and mortality was seen only in medical and obstetric thrombocytopenia. The low platelet counts and declining trend with increasing gestational age predispose Indian women to risk of thrombocytopenia and a routine platelet count is suggested.     

High plasma fibrinogen level is associated with poor clinical outcome in DIC patients

We measured the plasma level of fibrinogen in 560 patients with disseminated intravascular coagulation (DIC) and evaluated its relationship with outcome and with other hemostatic markers. Forty-seven percent of patients had >200 mg/dL of plasma fibrinogen and 24% had <100 mg/dl of plasma fibrinogen, suggesting that plasma fibrinogen level is not a sensitive marker for DIC. In our analysis of outcome and plasma fibrinogen levels, the rate of death was high in leukemia/lymphoma patients with high fibrinogen concentration, but no significant difference in outcome was observed in relation to plasma fibrinogen concentration in non-leukemia/lymphoma patients with DIC. Among patients with leukemia/lymphoma, the frequency of organ failure was markedly high in patients with high plasma levels of fibrinogen. Among patients without leukemia/lymphoma, the frequency of organ failure increased concomitantly with the increase in plasma fibrinogen levels. The international normalized ratio was significantly increased in leukemia/lymphoma patients with low fibrinogen. FDP levels were slightly increased in patients with low fibrinogen. Platelet count was significantly low in patients without leukemia/lymphoma with high fibrinogen. DIC score increased concomitantly with the reduction in plasma fibrinogen levels. Plasma levels of thrombomodulin and tissue factor were significantly high in patients with high fibrinogen levels. Plasma levels of antiplasmin and plasminogen were significantly decreased in patients with low fibrinogen. Plasma levels of plasmin plasmin-inhibitor complex and tissue type plasminogen activator/plasminogen activator inhibitor-1 complex (PAI-I) were significantly higher in patients with low fibrinogen than in those with high fibrinogen. Plasma levels of PAI-I and IL-6 were significantly higher in patients with high fibrinogen than in those with low fibrinogen. Patients with high fibrinogen levels showed less activation of secondary fibrinolysis, which might explain the occurrence of organ failure and poor outcome.     

产后失血性休克、DIC2例的抢救体会

临床资料产后大出血仍是我国目前孕产妇死亡的首要原因。因出血未得到及时、有效的控制,致严重贫血、组织缺氧,以及持续的低血容量状态诱发全身性炎症反应综合征(SIRS),多器官功能障碍综合征(MODS)和多器官衰竭(MOF)。本文报道2例诊治体会。例1患者女性,27岁。孕8月~ ,因“下腹痛4 h,阴道大出血1 h”到当地县医院就诊。B超提示胎盘早剥、宫内死胎。遂行急诊剖宫产术及子宫次全切除术,术后阴道流血不     

Plasma thrombomodulin as a marker of vascular disorders in thrombotic thrombocytopenic purpura and disseminated intravascular coagulation.

Plasma thrombomodulin (TM) levels were significantly elevated at disease onset in patients with thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC), but was not in those with essential thrombocythemia and idiopathic thrombocytopenic purpura. However, in patients with TTP and DIC, TM levels decreased significantly after they achieved complete remission. In both TTP and DIC patients, plasma TM levels at onset in those with poor prognosis were higher than that in those with good prognosis. Among DIC patients, the plasma TM level was higher in those with organ failure than in those without, but there were no differences among patients with various underlying diseases associated with DIC. It is speculated that the plasma TM level reflects damage to vascular endothelial cells or organ failure and that it is useful in assessing prognosis for patients with DIC and TTP.