产科弥漫性血管内凝血的临床分析

目的 探讨产科弥漫性血管内凝血(DIC)的发病原因、表现、诊断及处理方法.方法 回顾我院1998-2010年我院收治的20例产科DIC患者的临床资料.结果 产科DIC的发生原因依次为胎盘因素、宫缩乏力、重度子痫前期、妊娠合并症及羊水栓塞.表现以阴道流血为主.治疗以去除病因及成分输血补充血容量为关键.结论 加强产前宣教,...     

Effect of urinastatin on disseminated intravascular coagulation

Effect of urinary enzyme inhibitor urinastatin (MTI) on disseminated intravascular coagulation (DIC) was investigated. The prolongation of PTT and increase in FDP in endotoxin-induced DIC in rats were restored by the intravenous infusion of MTI. The reduction in platelet counts, decrease in fibrinogen level and prolongation of PT were partially suppressed by the drug. Furthermore, in vitro addition of MTI prevented the decrease in r and k values and increase in ma and m epsilon values in the thromboelastogram of whole blood in endotoxin-induced DIC in rabbits. It is suggested that MTI might prevent DIC in vivo and in vitro through the inhibition of Factor XII activity and through the prevention of thromboplastin release caused by endotoxin.     

纳武利尤单抗致弥漫性血管内凝血1例

目的 探讨恶性肿瘤治疗中免疫检查点抑制剂引起的免疫相关弥散性血管内凝血的临床特点和药学监护,为类似病例的诊治提供参考。方法 临床药师收集1例纳武利尤单抗致弥散性血管内凝血患者的诊疗资料,通过评价药物与不良事件之间的关联性,分析患者出现弥散性血管内凝血的用药因素,并在用药治疗过程中实施药学监护。结果 患者经糖皮质激素治疗后,凝血功能改善。结论 纳武利尤单抗可能引起弥散性血管内凝血,在临床中较为罕见,一旦出现类似症状,应积极明确诊断,及时采取治疗措施,保障患者用药安全。     

弥散性血管内凝血40例临床分析

目的 探讨弥散性血管内凝血(DIC)患者的临床特征。方法 回顾性分析40例DIC患者的临床资料。结果 DIC临床表现多样,40例患者中,好转28例,死亡12例。结论 DIC病情重,死亡率高,临床应重视其早期诊治。     

Paeoniflorin alleviates lipopolysaccharide-induced disseminated intravascular coagulation by inhibiting inflammation and coagulation activation

Lipopolysaccharide (LPS) is a toxic component of the outer membrane of gram-negative bacteria that can activate the blood coagulation system, leading to disseminated intravascular coagulation (DIC). DIC is a syndrome characterized by thromboembolism and multiple organ failure. Herein, the beneficial effect of paeoniflorin (PF) on the alleviation of LPS-induced DIC was investigated with an experimental DIC mouse model. Briefly, mice were randomly divided into the following six groups: (1) control; (2) LPS; (3) heparin; (4) low-PF treatment; (5) medium-PF treatment; and (6) high-PF treatment. The histological morphology of the liver and kidney was observed, and the coagulation indicators (such as prothrombin time), function indicators (such as alanine transferase), and inflammatory factors (such as TNF-α) were detected. Additionally, an in vitro cell inflammation model using RAW 264.7 murine macrophages was established. Activation of the nuclear factor kappa B (NF-κB) signaling pathway and tumor necrosis factor-α (TNF-α) were determined by western blotting. Based on our findings, PF could significantly improve the histological morphology of the liver and kidney, indicating that PF protects the liver and kidney against damage induced by LPS. Additionally, PF improved the function and coagulation indicators and reduced the production of inflammatory factors. In vitro, PF inhibited the expression of TNF-α by suppressing NF-κB signaling pathway activation. Collectively, our findings support the hypothesis that PF has anti-inflammatory and anticoagulation effects for the alleviation of LPS-induced DIC. PF is thus a potential co-treatment option for DIC.     

15例产科DIC肝素应用探讨

目的 探讨产科弥漫性血管内凝血(DIC)中肝素的合理应用。方法 对本院近十二年来收治产科DIC 15例(其中应用肝素13例)进行临床分析。结果 孕产妇抢救成功14例，死亡1例，死亡率6．6％。结论 在产科DIC的救治中，早期诊断、及时去除病因以及肝素的合理使用是抢救成功的关键。     

Endotoxin-induced disseminated intravascular coagulation in vitamin E deficient rats

The effect of vitamin E on endotoxin-induced experimental disseminated intravascular coagulation (DIC) was studied in rats deficient in and supplemented with vitamin E. Experimental DIC was induced by a 4-hr sustained infusion of endotoxin at a dose of 13.3 mg/kg. After the infusion, fibrinogen and fibrin degradation products were increased, platelet count and fibrinogen level were decreased, and prothrombin time and partial thromboplastin time were prolonged. In addition, the number of renal glomeruli with fibrin thrombi was increased. These changes were significantly greater in vitamin E deficient rats when compared to those changes found in rats supplemented with vitamin E. These results indicate that vitamin E plays a protective role in endotoxin-induced DIC.     

产科弥漫性血管内凝血28例临床分析

目的：探讨产科弥漫性血管内凝血的发生原因、治疗方案及其预后的影响因素。方法选择2006年1月~2014年1月在我院妇产科收治的28例发生弥漫性血管内凝血的孕妇作为本次临床观察的研究对象,回顾性分析孕妇发生弥漫性血管内凝血的原因及其临床表现,探讨弥漫性血管内凝血的临床治疗效果。结果28例孕妇均抢救成功,无产妇死亡病例;子宫全切除的患者有3例,次全子宫切除患者1例,子宫动脉灌注栓塞术患者6例。胎儿情况,新生儿存活27例,宫内死亡1例,死胎4例,新生儿死亡率为15.62%。患者在弥漫性血管内凝血治疗前后,凝血功能有明显区别。在治疗后,患者的凝血功能有着明显改善。结论弥漫性血管内凝血的治疗主要是及时并且有效地将引起弥漫性血管内凝血的病因去除,同时进行有效的止血、补充血容量等相关的对症治疗。子宫动脉灌注栓塞术及再次开腹探查时加行B-Lynch子宫缝扎术,对保留子宫起了非常重要的作用。     

急性早幼粒细胞白血病合并弥漫性血管内凝血的临床研究

目的分析急性早幼粒细胞白血病(APL)并发弥漫性血管内凝血(DIC)的临床、实验室特征及治疗情况,探索DIC死亡的危险因素。方法对2004年1月至2010年9月中国医科大学附属第一医院血液科收治的156例初治APL患者进行病例总结与分析。结果 156例患者中64例(41.0%)合并DIC,中位发生时间为10d。APL合并DIC患者出血广泛且严重,微血管栓塞表现少见。合并DIC患者完全缓解率为63%,早期病死率为33%,达完全缓解时间为44(25～78)d,治疗中并发维甲酸综合征占17%,与非DIC组比较差异有统计学意义(P=0.000、0.035、0.001、0.029)。维甲酸联合砷剂治疗可缩短DIC治愈时间。DIC组患者复发率为20%,明显高于非DIC组(8%,P=0.031)。DIC组患者总生存时间为12(0.1～65)个月,5年总生存(OS)率为(56±7)%,与非DIC组相比差异有统计学意义(P=0.001);DIC组无复发生存(RFS)时间为17.5(3～65)个月,5年RFS率为(74±8)%,与非DIC组差异无统计学意义(P=0.052)。多因素分析显示血浆纤维蛋白原(Fbg)、外周血白细胞数、生存状态评分(PS评分)是APL合并DIC死亡的危险因素。结论 DIC是APL最严重的并发症之一,为APL致死及导致不良预后的直接原因,应早期诊断。血浆Fbg<1.0g/L、白细胞>20×109/L、PS评分2～4分预示DIC高危、病死率极高,应早期进行维甲酸及砷剂联合诱导治疗。     

探讨肝素在治疗新生儿弥漫性血管内凝血中的剂量、给药方法及时机

目的探讨肝素在治疗新生儿弥漫性血管内凝血（D1C）中的剂量、给药方法及时机。方法选择2010年10月至2013年4月我院发生DIC的40例新生儿为研究对象。将其随机分为实验组和对照组,各20例。所有患儿均行综合治疗,实验组早期静脉注射微剂量肝素治疗,对照组静脉注射常规剂量肝素治疗。观察比较两组患儿住院天数、住院费用、治愈率、病死率及不良反应发生情况。结果实验组住院天数、住院费用、治愈率、病死率与对照组比较,差异均具有统计学意义（P〈0．05）。所有存活患儿均无出血倾向。结论早期静脉注射小剂量肝素治疗各期新生儿DIC,安全有效,不良反应少,值得临床推广使用。     

Simultaneous determination of coagulation and fibrinolysis parameters for diagnostics of disseminated intravascular blood coagulation (DIC).

A diagnostic method is described for determining the parameters of the human blood plasma coagulation and fibrinolysis by turbidimetry. Diluted plasma with thrombin and streptokinase is mixed to initiate clot formation and subsequent clot dissolution. The resultant profile of absorbance versus time is analysed to determine six parameters: plasma coagulation time, the rate of coagulation, fibrinogen concentration, the rate of fibrinolysis, fibrin clot half-lysis and lysis time. The assay is precise, sensitive and requires 0.1 ml plasma. The method has a good correlation with generally accepted haemostatic tests and allowed us to recognize the stage of DIC syndrome for less than 10 minutes. This new approach was successfully applied for studying the haemostasis in patients with acute intestinal infection.     

重组水蛭素治疗兔弥散性血管内凝血

目的:观察重组水蛭素对治疗脂多糖致兔弥散性血管内凝血模型的抗凝疗效。方法:建立兔脂多糖弥散性血管内凝血模型,18只新西兰大白兔随机分为3组,静脉注射脂多糖的同时分别予生理盐水、普通肝素和重组水蛭素,于注射脂多糖前,注射后2,4,6h检测血小板计数、活化部分凝血活酶时间、抗凝血酶Ⅲ、纤维蛋白原、血清纤维蛋白降解产物(FDP);并观察心、肺脏器的病理变化。结果:模型组兔活化部分凝血活酶时间明显延长,血小板计数和纤维蛋白原显著降低,抗凝血酶Ⅲ活性明显下降,与肝素组相比重组水蛭素组血小板和纤维蛋白原消耗减少,抗凝血酶Ⅲ活性下降程度减轻。所有实验动物血清FDP变化无统计学差异。病理检查模型组心、肝、肺、肾、脾脏可见微血栓形成,重组水蛭素组均未见微血栓形成。结论:重组水蛭素具有明显的抗凝作用,可有效治疗弥散性血管内凝血。     

磷霉素过敏致弥散性血管内凝血死亡

1例51岁男性患者,因发热、寒战给予复方氨林巴比妥2mL肌内注射。因效果不佳,遂于1h后给予磷霉素4g加入5%葡萄糖注射液250mL中静脉滴注。输注过程中患者出现胸闷,气促,寒战症状加重。遂停止输液,经治疗症状无好转,且出现呼吸困难。次日患者颜面及全身皮肤明显发绀、出现大片花斑,眼睑水肿,结膜充血,四肢湿冷,双肺可闻及湿啰音.实验室检查：PLT45×10^9/L。血浆凝血酶原时间37.3s,活化部分凝血活酶时间78.1s,血浆D-二聚体1600～3200μg/L。最终,患者经抢救无效死亡。     

凝血与纤溶系统水平对产妇弥漫性血管内凝血的早期诊断价值

目的通过观察DIC产妇中凝血与纤溶系统水平的变化,探讨其是否可以作为产妇DIC的早期诊断指标,评价其诊断价值。方法选取2009年1月～2011年6月在笔者所在医院进行治疗的32例DIC产妇和进行体检的30例健康产妇,对两组受试者的凝血与纤溶系统多种指标进行检查。结果与对照组产妇比较,DIC组的PLT计数和FIB水平显著降低,而PT、TT及APTT显著增加,D-D升高,两组受试者比较,差异有统计学意义(P<0.05)。结论凝血与纤溶系统水平对于产妇DIC的早期诊断具有重要的意义,其中PT、TT及APTT显著性增加表明凝血功能亢进,而D-D升高表明继发性纤溶的发生,上述指标的变化可以作为产妇DIC早期诊断的指标。     

妊娠并发DIC15例临床分析

目的：探讨妊娠并发弥漫性血管内凝血（DIC）对母婴结局的影响。方法：回顾性分析2001年1月～2011年4月本院10年间妊娠并发DIC15例孕产妇的临床资料。结果：DIC的诱发因素有产后出血6例,胎盘早剥5例,子痫3例,羊水栓塞1例;母婴结局为孕产妇死亡0例,围产儿死亡4例,产妇急性肾功能衰竭1例,剖宫产12例,子宫切除5例。结论：妊娠并发DIC与胎盘早剥、产后出血关系密切,在积极治疗同时应防治产妇并发症尤其是肾功能的保护和监测。